Anomalies and Curiosities of Medicine [337]
compress soaked in warm olive oil was then placed over the scalp, covered with oiled silk and with a recurrent bandage. A considerable portion of the wound healed by adhesions, and the patient was discharged, cured, in fifty-four days. No exfoliation of bone occurred. Reverdin, a relative of the discoverer of transplantation of skin, reported the case of a girl of twenty-one whose entire scalp was detached by her hair being caught in machinery, leaving a wound measuring 35 cm. from the root of the nose to the nape of the neck, 28 cm. from one ear to the other, and 57 cm. in circumference. Grafts from the rabbit and dog failed, and the skin from the amputated stump of a boy was employed, and the patient was able to leave the hospital in seven months. Cowley speaks of a girl of fourteen whose hair was caught in the revolving shaft of a steam-engine, which resulted in the tearing off of her whole scalp. A triangular portion of the skin was hanging over her face, the apex of the triangle containing short hair, from which the long hair had been detached. Both ears were hanging down the neck, having been detached above. The right pinna was entire, and the upper half of the left pinna had disappeared. The whole of the head and back of the neck was denuded of skin. One of the temporal arteries was ligated, and the scalp cleansed and reapplied. The hanging ears and the skin of the forehead were successfully restored to their proper position. The patient had no bad symptoms and little pain, and the shock was slight. Where the periosteum had sloughed the bone was granulating, and at the time of the report skin-grafting was shortly to be tried.
Schaeffer has presented quite an extensive article on scalp-injuries in which grafting and transplantation has been used, and besides reporting his own he mentions several other cases. One was that of a young lady of twenty- four. While at work under a revolving shaft in a laundry the wind blew her hair and it was caught in the shaft. The entire skull was laid bare from the margin of the eyelids to the neck. The nasal bones were uncovered and broken, exposing the superior nasal meatus. The skin of the eyelids was removed from within three mm. of their edges. The lower margin of the wound was traceable from the lower portion of the left external process of the frontal bone, downward and backward below the left ear (which was entirely removed), thence across the neck, five cm. below the superior curved line of the occipital bone, and forward through the lower one-third of the right auricle to the right external angular process of the frontal bone and margin of the right upper eyelid, across the lid, nose, and left eyelid, to the point of commencement. Every vessel and nerve supplying the scalp was destroyed, and the pericranium was torn off in three places, one of the denuded spots measuring five by seven cm. and another five by six cm. The neck flap of the wound fell away from the muscular structures beneath it, exposing the trapezius muscle almost one-half the distance to the shoulder blade. The right ear was torn across in its lower third, and hung by the side of the neck by a piece of skin less than five mm. wide. The exposed surface of the wound measured 40 cm. from before back, and 34 cm. in width near the temporal portion. The cranial sutures were distinctly seen in several places, and only a few muscular fibers of the temporal were left on each side. Hemorrhage was profuse from the temporal, occipital, and posterior auricular arteries, which were tied. The patient was seen three-quarters of an hour after the injury, and the mangled scalp was thoroughly washed in warm carbolized water, and stitched back in position, after the hair was cut from the outer surface. Six weeks after the injury suppuration was still free, and skin-grafting was commenced. In all, 4800 grafts were used, the patient supplying at different times 1800 small grafts. Her own skin invariably did better than foreign grafts. In ten months she had almost completely recovered, and sight and hearing had returned. Figure
Schaeffer has presented quite an extensive article on scalp-injuries in which grafting and transplantation has been used, and besides reporting his own he mentions several other cases. One was that of a young lady of twenty- four. While at work under a revolving shaft in a laundry the wind blew her hair and it was caught in the shaft. The entire skull was laid bare from the margin of the eyelids to the neck. The nasal bones were uncovered and broken, exposing the superior nasal meatus. The skin of the eyelids was removed from within three mm. of their edges. The lower margin of the wound was traceable from the lower portion of the left external process of the frontal bone, downward and backward below the left ear (which was entirely removed), thence across the neck, five cm. below the superior curved line of the occipital bone, and forward through the lower one-third of the right auricle to the right external angular process of the frontal bone and margin of the right upper eyelid, across the lid, nose, and left eyelid, to the point of commencement. Every vessel and nerve supplying the scalp was destroyed, and the pericranium was torn off in three places, one of the denuded spots measuring five by seven cm. and another five by six cm. The neck flap of the wound fell away from the muscular structures beneath it, exposing the trapezius muscle almost one-half the distance to the shoulder blade. The right ear was torn across in its lower third, and hung by the side of the neck by a piece of skin less than five mm. wide. The exposed surface of the wound measured 40 cm. from before back, and 34 cm. in width near the temporal portion. The cranial sutures were distinctly seen in several places, and only a few muscular fibers of the temporal were left on each side. Hemorrhage was profuse from the temporal, occipital, and posterior auricular arteries, which were tied. The patient was seen three-quarters of an hour after the injury, and the mangled scalp was thoroughly washed in warm carbolized water, and stitched back in position, after the hair was cut from the outer surface. Six weeks after the injury suppuration was still free, and skin-grafting was commenced. In all, 4800 grafts were used, the patient supplying at different times 1800 small grafts. Her own skin invariably did better than foreign grafts. In ten months she had almost completely recovered, and sight and hearing had returned. Figure