Surgical reconstruction of the nose by modified frontal method.

Date:
1933
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Credit

Surgical reconstruction of the nose by modified frontal method. Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Source: Wellcome Collection.

About this work

Description

Treatment of a boy aged 10 suffering from total loss of nose by lupus. Endotracheal anaesthesia. First stage: lining of new nose and shaping of nostrils by skin flaps. Second stage: after three weeks, returning flaps to forehead. Epithelial graft from thigh to remaining raw area on forehead. Fixation of stent mould. Third stage: preparation of rib cartilage to form support for new nose. 6 segments.

Publication/Creation

England, 1933.

Physical description

1 encoded moving image (37 min.) : silent, black and white

Duration

00:36:18

Contents

Segment 1 The patient is introduced, a ten-year-old boy suffering from total loss of his nose due to lupus. The boy moves his head from side to side to show all the angles of his head. The intertitles explain that his lupus has been cured at the Lord Mayor Treloar's home under Sir Henry Gauvain. The first stage of the reconstructive surgery begins with an intratracheal anaesthesia performed by Dr I.W. Magill. Next, the pharynx is packed, and then a raw surface is prepared on the lip and the skin above the lip. A flap is reflected to form the lining of the new nose, and the flap being sliced away is shown. Next, the tip of the inturned flap is sewn to the prepared spot on the lip, and the flap folded with catgut stitches to give shape to the nostrils. Time start: 00:00:00:00 Time end: 00:05:54:21 Length: 00:05:54:21
Segment 2 A template in tinfoil of the covering flap is prepared. The main part of the surgery of this stage now takes place, with a sickle shaped flap being taken from the forehead and brought down to cover the local lining flap. This flap is sewn to the other flap to create the nose shape. The nostrils are sewn. Time start: 00:05:54:21 Time end: 00:12:03:06 Length: 00:06:08:14
Segment 3 The intertitles explain that a mattress suture through the covering flap sometimes improves appearance, but is very dangerous to its blood supply, and the nose being sewn up is shown some more. The forehead is bandaged. The second stage of surgery begins three weeks after the first stage. The pedicle is divided, opened and returned to the forehead. The skin is cut away from the top of the nose, notched and reattached to the forehead. Time start: 00:12:03:06 Time end: 00:17:51:09 Length: 00:05:38:02
Segment 4 Granulations are removed from the scalp, and the top of the nose is trimmed, and the top of it sewn in. An epithelial graft cut from the thigh covers the remaining raw area on the forehead. Time start: 00:17:51:09 Time end: 00:23:56:21 Length: 00:06:15:12
Segment 5 A stent mould is used to press the graft evenly onto its bed, and then fixed using mastisal and gauze. The boy is seen smiling and recovering from the second stage of surgery in a bed. The third stage of surgery begins, with a section of rib cartilage being removed to form a support for the new nose. Time start: 00:23:56:21 Time end: 00:30:05:08 Length: 00:06:08:16
Segment 6 The chest is sewn back up. The cartilage is seen being carved into the correct shape to make a hinged graft. The cartilage is put into the nose and the nose sewn back up. The surgeon turns the boy's head on the operating table, to show it from different angles. In the final scenes, we see the boy smiling with his finished nose. Time start: 00:30:05:08 Time end: 00:36:19:14 Length: 00:06:14:06

Creator/production credits

Produced by Sir Harold Gillies.

Terms of use

Open with advisory.
CC-BY-NC

Copyright note

British Medical Association

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