Tonks Illustration Case 2

Image 1 is a reproduction from an original servicemen’s record into which Tonks’ diagram of one procedure has been inserted in order to explain what had been done. Something that is not always obvious by looking at the patient. It depicts the reconstruction of a lower lip lost to a blast injury.

In a first operation on 2.11.26, flaps of tissue are mobilised and advanced from the margins of the intact lower lip and chin. In these illustrations the capital letters (A) always end up sutured to the tissue marked with a corresponding “primed” capital (A’). It is noted however that “Part of this sloughed”. Slough is dead tissue cause by inadequate blood supply or infection.

A second procedure becomes necessary, which is illustrated by Tonks. Removal of scar from the first operation is undertaken before reconstruction of the missing portion of lower lip mucosa by borrowing a flap from inside the upper lip. Once sewn into place, it remains attached to its pedicle or “base of attachment” as it is described, for some five weeks until 16.5.17.

A third operation on that date is illustrated in miniature by Tonks and demonstrates the separation of the lip flap from its base and previous source of blood supply. The mucous membrane of the upper lip flap is then sutured forwards to reconstruct the similar structure of the lower lip. This conforms to one of Gillies’ maxims which is to “replace like with like”.

Image 2 shows the same procedure and illustrations formalised and published in “Plastic Surgery of the Face”.