OPERATIONS ON THE LIDS 49 



in 1909, Dr. S. Lewis Ziegler described a method of "gal- 

 vanocautery puncture in ectropion and entropion." He 

 uses a special clamp for this purpose, in which the lid 

 is fixed; then makes, in ectropion, about six punctures 

 of the tarsus at equal distances apart with a special 

 galvanocautery tip. For entropion, the punctures are 

 made on the skin surface. He has seldom seen any 

 -reaction following its use. If after the first operation 

 the result is not satisfactory, the operation may be re- 

 peated in two or three weeks. 



In extensive cicatrices, or in cases of destruction of the 

 tissues of the lid, plastic operations are often done to 

 restore the lid. Such operations are well illustrated in 



Figs. 14-17- 



The cicatrix or ulcerated surface is excised and new 

 tissue suppHed by a flap from the cheek or forehead. 

 If too much tension is produced in drawing together by 

 sutures the wound from which the flap was taken, it may 

 be covered with Thiersch grafts. Such grafts are taken 

 from the leg usually. The hair must first be shaved and 

 the site made as aseptic as possible. A portion of the 

 upper surface of the skin is then cut away with a to-and- 

 fro motion of the razor. The razor should be flooded 

 with normal salt solution, so that the grafts will slide 

 off easily without curling. They should be imme- 

 diately transferred as soon as ah bleeding has been 

 stopped. The grafts are then protected with per- 



