Identifier: breastitsanomali00deav (find matches)
Title: The breast: its anomalies, its diseases, and their treatment
Year: 1917 (1910s)
Authors: Deaver, John B. (John Blair), 1855-1931
Subjects: Breast Breast X-rays Breast Diseases Breast Neoplasms Radiotherapy
Publisher: Philadelphia, P. Blakiston's Son & Co
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons

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Fig. 204.—Halsteds method of radical amputation of the breast. The edges of the skin are sewed tothe sides of the chest wall and the defect is covered with Thiersch grafts. Skin Grafting in the Operation for Carcinoma of the Breast.—Of late years we havenot used skin grafts in the primary operation; complete closure of the wound is usuallypossible if the flaps are sufficiently undermined, and we can see no objection to this pro-cedure. Occasionally it becomes necessary to fashion a flap to meet the exigencies ofthe particular case and sometimes it is necessary to make small incisions in the flaps oneither side of the primary incision to relieve the tension, but this is exceptional. In rareinstances, necrosis of the flaps takes place about the mid-point of the incision where the 582 THE BREAST flaps are under the greatest tension and if the resulting defect be large, it must be closed;under these circumstances skin grafting is preferable to any plastic method.
Text Appearing After Image:
Fig. 205.—Halsteds method of skin grafting after radical amputation of the breast. There are, however, good arguments to be advanced for skin grafting as a primarystep in the operation. According to Halsted, the statistics at the Johns Hopkins Hospital CARCINOMA 583 show that the best results in the treatment of carcinoma of the breast have beenobtained by those who removed the most skin. This is the best reason that could beadvanced for so doing, but it does not prove that complete closure of the wound isincompatible with renioval of sufficient areas of skin. The skin grafts are said topresent a definite obstacle to the dissemination of cancer metastases, and on thisaccount Halsted suggests that a moat be made around the cancer laden skin incases of cancer en cuirasse by removing a strip of healthy skin and when granula-tion begins in the moat thus produced, that Reverdin grafts be made. As regards the technic of skin grafting after the radical excision of the breast, thisdiffers b

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