Supplementing a photographic set-up for the plastic surgeon

S U P P L E M E N T I N G A PHOTOGRAPHIC SET-UP FOR THE PLASTIC SURGEON By MILTON TUERK, M.D., D.D.S., F.A.C.S. Long Island, New York PHOTOGRAPHY is an integral part of plastic and reconstructive surgical practice. Adequate pre-operative, operative, and post-operative photographs are almost equally important for comparison and evaluation of resuks. An adequate set-up for taking such photographic records has already been described (Tuerk et al., I956). However, this type of set-up requires many component parts. If one operates in one or two hospitals, it is possible to leave dup.licate arrangements in each. When one operates in many hospitals, a more portable set-up can be improvised using the previously described equipment with a battery-powered electronic flash, all packaged into a small carry case. On occasion, either due to breakdown of my photographic equipment, or its unavailability, many a good photographic opportunity has been lost. I have therefore sought for a practical means of obtaining adequate pictures at all times utilising a minimum of readily available equipment. The use of the ultraminiature camera provides such an ancillary method. The technique to be described is not meant to replace that previously described, since I fully realise that a single-lens reflex camera utilising the newer fast-speed colour reversal film can produce transparencies suitable for all medical purposes (viewing, projection, or prints). This method is meant rather to supplement one's basic photographic technique. I have found the ..... FIG. I Minox B, one of the ultraminiature precision cameras, to provide me with all the equipment I Camera size. require. I routinely employ a 35 ram. Exacta camera for all photos, using colour film and electronic flash. In addition, where I wish black and white prints, or when my 35 mm. camera equipment is unavailable, I make use of the ultraminiature camera. The camera is approximately the size of a package of chewing gum and weighs 2{ oz. (Fig. I). It has a self-contained semi-automatic exposure meter (photoelectric). The lens is a compound f3"5 of 15 ram. focal length with a focal plane shutter having speeds ranging from ½ second to I/I,OOO second with a bulb and time setting. There are bulk-in filters, an exposure counter, an automatic parallax corrector, and an X flash synchronisation. Film advancement is a simple push-pull setting. For sharpness of image, there is a depth of field scale running from 8 in. to infinity. The film format is 8 by II mm., and is cassette-loaded. The lens has no diaphragm opening as exposure is controlled by altering the shooting speed. Io9

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This makes for simplicity in operation. The camera comes in a small leather case with an attached beaded chain pre-marked in measured distances from 8 to 24 in. for close-up photography.

FIG. 2 Severe facial lacerations bilaterally.

FIG. 3 Laceration of ear.

FIG. 4 Ulcer of cheek.

While there are many films available for the camera (e.g., ASA 25, 50, 2oo, and 400, Agfacolor CN 14, Anscochrome, and Agfa T 18), I employ only one film, Trixpan, with a speed rating of 4oo ASA. This gives an ultra-fast film providing a good tonal range of greys and minimal grain and can be employed with ordinary Tungsten light. Roomlight is sufficient to provide an adequate black

PHOTOGRAPHIC

SET-UP

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PLASTIC

SURGEON

FIG. 5

FIG. 6

Peri-anal region.

Close-up view of pigmented nmvus.

FIG. 7 Hypertrophic scar of shoulder.

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FIG. 8 Scar excision afxd repair (same patient as Fig 7)-

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and white photographic recording at camera speeds of I/2o and I/5O of a second. An operating room spotlight gives more than sufficient light to use speeds of I/5oo to I/I,OOO of a second.

FIG. 9

FIG.

Amputation of distal finger tip.

IO

Skin graft to defect (same patient as Fig. 9).

FIG. I I

Forehead laceration.

The small size of the camera enables one to carry it along at all times. In using the camera, a reading is taken with the exposure meter ; the coupled speedsetting is then turned to correspond with the locked-in position of the exposure meter dial, and this automatically gives the correct speed setting. No f numbers

PHOTOGRAPHIC

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PLASTIC

SURGEON

FIG. I2

Partial avulsion of nose.

FIG. 13 Laceration of outer lower lip.

FIG. I4 Laceration of inner lower lip (same patient as Figure x3).

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FIG. 15

FIG. I6

Ankyloglossia.

Notching of lateral nose after excision of carcinoma.

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FIG. I7 Decubitus ulcer in a paraplegic.

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are required as the lens has no diaphragm settings. I use the 8 and Io in. distance for most of my photography. At this distance I have depth of field of i to I 1 in. and I can cover a subject area of 4½ by 6~- to 5 by 7 in. For larger subject areas, the camera may be moved back to i2, 18, or 24 in. There is a subject field size and depth field table available for all camera distances (see Minox Owners Manual). After using the beaded chain for measuring the subject camera distance, an exposure

FIG. I8

FIG. 19

Laceration of upper lip.

Laceration of eyebrow.

is then made. Closing and opening the camera automatically winds the shutter and advances the film. Despite the fact that built-in flash synchronisation is available, I have never had occasion to use this since the film is fast enough to use with ordinary light. The film comes in thirty-six exposure cassettes and is processed by the Minox Laboratories ; prints are returned within three days in an enlarged size 2~ by 3~ or larger. Processing charges are nominal. A choice of photographic paper is offered, although glossy is preferred for future reproduction. Figures 2 to I9 are clinical photographs taken with this camera.

REFERENCE TUERK, M., TREVASKIS,A. E., and MARCKS, K. M. (I956). XT, 477.

Plast. reconstr. Surg.,

Submitted for publication, September I963.