of it has had to be built up again de novo. It does not fall to the lot of every surgeon to see even one cheiloplasty in his training.
The earlier months, then, were spent in a very thorough trial of the then known methods. It has been illuminating to discover the impracticability of many of these, which would appear to have been put forward on the study of one case only, or even on purely theoretical grounds. Among the sponsors of really practicable methods the names of Tagliacozzi, Nelaton, Keegan, and Smith stand out prominently.
PRINCIPLES
It is the author's aim here to discuss principles in the order of their application in a given case. They will thus be dealt with, in the following order:
History, etc. Anæsthesia.
Examination. Operation.
Early treatment. General Technique.
Planning the repair. Stages.
1. Lining Membrane. Suture.
2. Contour and Supports. Dressings.
3. Covering Tissues. After Treatment.
HISTORY, ETC.
The history of the injury is obtained, together with any existing record of the early condition, and if possible of the condition prior to injury. It is of importance also to obtain information as to the presence of luctic or tubercular taint, and as to the patient's healing powers as shown in former operations.
EXAMINATION
The majority of failures in plastic surgery are due to errors the commission of which would lead to failure in any form of surgery. Thus, mistakes in diagnosis due to inadequate examination are perhaps the commonest cause of indifferent treatment. This element of difficulty in diagnosis may not at first sight be obvious. The word diagnosis in this work is used in its literal sense, namely, to mean a thorough knowledge of the condition present i.e. the exact loss in terms of anatomical structure.
The routine examination of our cases, with preparation of records of the condition on admission, occupies nearly a week ; but the time so lost is regained a hundredfold. The examination merely of the surface of. the lesion, simple as
