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bronchial irritation, or rise of temperature at the time selected for operation, it is safer to defer the work.

Asepsis rather than antisepsis should be maintained throughout the operation, and during convalescence, since infection is one of the chief causes of failure. It goes without saying that rubber gloves should be worn by the operator and all assistants.

The tissues should be treated with the greatest consideration. Keen-cutting instruments must be used to avoid unnecessary bruising of the tissues. The flaps should be handled with special forceps, or small sharp hooks (Fig. i). The area into which the flap or graft is to be transferred should be perfectly dry, and all hemorrhage checked, in as much as many failures are due to a blood clot forming beneath the transplant, which prevents the early acquisition of a new blood supply.

If possible, all scar tissue, deep or superficial, should be removed. An accurate estimate of immediate and subsequent tissue shrinkage must be planned for. Accurate apposition of the skin edges is desirable, as prompt healing minimizes scar tissue.

One of the most important points in plastic surgery when tissue of any kind is transplanted, is that there be no tension either on the flaps, or on free grafts. Always remove a suture if it blanches the tissue, or causes too much tension. I like to see a surgeon who, when doing plastic work does not hesitate, in spite of his audience, to take out sutures which are too tight or which have not been placed exactly to suit him.

As a rule prosthesis should be avoided, as it is rare in plastic surgery that we encounter a deformity which cannot be helped by logical surgical methods. At best the surgeon can accomplish only a certain amount, nature (when obstacles are removed) being relied on to complete his work.

To sum up the matter, in the words of Sir Frederick Treves,^[1]