War surgery of the faceA treatise on plastic restoration after facial injury by John BRoberts ..Prepared at the suggestion of the subsection on plastic and oral surgery connected with the office of the surgeon generalIllustrated with 256 figures . s just mentioned. By appropriatemodelling with stitches an acceptable nose, with alae, columella,and nostrils, is formed. The frontal bone may lose a thin layer of its surface by necro-sis, because its periosteum has been removed, but when granula-tion has occurred Thiersch grafts are applied, and the finalscarring is said to be not very deforming. I
War surgery of the faceA treatise on plastic restoration after facial injury by John BRoberts ..Prepared at the suggestion of the subsection on plastic and oral surgery connected with the office of the surgeon generalIllustrated with 256 figures . s just mentioned. By appropriatemodelling with stitches an acceptable nose, with alae, columella,and nostrils, is formed. The frontal bone may lose a thin layer of its surface by necro-sis, because its periosteum has been removed, but when granula-tion has occurred Thiersch grafts are applied, and the finalscarring is said to be not very deforming. In brachial rhinoplasty the flap for the new nose may be cutfrom the upper arm or the forearm, or a pedunculated flap fromthe thigh or abdomen may be grafted upon the hand and subse-quently transported to the nasal region, just as if it had origi-nally been formed from brachial tissues. The retentive appa- 354 WAR SURGERY OF THE FACE. ratus to hold the arm or hand close to the face may be made frombandages and gypsum or from leather and webbing. The patientmay be fitted with such appliances and wear them for a timeprior to operation, in order to become inured to the discomfortdue to their use. The method of transportation by hand is of more. Fig. 174.— Gunshot injury repaired by frontal flap. (Courtesy of Dr. H. W Scarlett.) value probably when partial rhinoplasty is to be done, becauseeven it scarcely can give sufficient rigidity to form an acceptableorgan in total rhinoplasty. Schimmelbusch has devised a method in which he uses a largeosteoplastic flap from the forehead and slides large areas of thescalp from the temporal regions to cover the denuded bony flap is covered with Thiersch grafts and then reversed. REPAIR OF DEFORMITIES OF EXTERNAL NOSE. 355 Some operators have employed both frontal and bracial flaps,superimposing one upon the other. For the various deformities requiring partial rhinoplastiesthere are almost innumerable operative devices. In subtotal lo
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