The simpler the operation the more likely it is to succeed, and this is especially exemplified in the operations for the relief of harelip. It is wise to make haste slowly in plastic surgery, and to underdo rather than overdo.
The plastic surgeon, with his special knowledge of tissue transplantation, can be of great use to the general surgeon, and to the orthopedist in dealing with scars and in repairing the defects left by certain necessarily mutilating operations. This applies also to the gynecologist, and genito-urinary surgeon, when their patients require more extensive transplantations than these specialists are accustomed to undertake.
Plastic surgery cannot be done in a hurry, either in the operative steps in the process or in the length of time required to complete the final operation. Frequently in complicated cases single operations require several hours to complete, on account of the great detail necessary and the difficulties encountered in carrying out the work. Sometimes the patient may be in the hospital for months (combating infection), before he is even ready for operation, and then be obliged to undergo several major operations with interspersed minor procedures. Ten, twenty, and even more operations may be necessary to accomplish the desired result, and thus it can readily be seen that this work is a tremendous tax on both patient and surgeon. Fortunately, the majority of the patients requiring these operations are endowed with extraordinary fortitude, and occasionally the surgeon is found who is able to give his interested attention to this work.
Thorough familiarity with the free transplantation of skin, fat, fascia, bone and cartilage, is essential, as all of these tissues are constantly utilized in reconstructive work. The principles of tissue shifting and of the use of pedunculated flaps must be understood, and also the possibilities of combinations with the above-mentioned free transplants.
For all sorts of plastic operations it is desirable that the patient should be in the best possible physical condition, and no plastic operation should be undertaken on those still suffering from active local disease. A complete physical examination should be made of each case before operation, and in children the urine should be examined with special reference to the presence of acetone and diacetic acid. Low hemoglobin contraindicates operation on the ordinary case, and I seldom care to operate when the percentage is below 75. If there is
