Tonks Illustration Case 3

This case demonstrates the use if three media to capture the process of treating this soldier.

Image 1 reproduces a page from Gillies 1920 textbook “Plastic Surgery of the Face”. At top left, the the patient is some weeks from an injury resulting in loss of this lower lip, chin and part of the lower jaw. His mouth is not continent and he dribbles saliva. At top right he appears in one of Tonks iconic pastel images. At bottom, we see the final result of surgery with an intact lip and chin. The patient appears much less harrowed and distressed than he did in the pre-operative images.

Image 2 is a depiction of the inferiorly based local, naso-labial flap used in the reconstruction together with the secondary flap of mucosa (x) used to line the inside of the new lip. In these illustrations the capital letters (A) always end up sutured to the tissue marked with a corresponding “primed” capital (A’).

Image 3 depicts the bone graft inserted, and secured into the lower jaw (mandible) to make up for bone lost to the injury. The proximal end appears pinned, the distal end being inserted in the manner of a peg into the medullary cavity of the mandible.