Plastic surgery; its principles and practice . d, turned down, and sutured to the freshened border of the nasal defect. A double flap may also be made by turning on itself a flap from thearm. After union of the raw surfaces, the edges are freshened and theflap is implanted into the defect. This method will be illustrated laterin an operation of the authors for the repair of a cheek defect. The flap may be lined with skin by grafting the under surface SURGERY OF THE EXTERNAL NOSE 449 either with OlHer-Thiersch, or with whole-thickness grafts, by theopen or by the buried methods, and allowing he
Plastic surgery; its principles and practice . d, turned down, and sutured to the freshened border of the nasal defect. A double flap may also be made by turning on itself a flap from thearm. After union of the raw surfaces, the edges are freshened and theflap is implanted into the defect. This method will be illustrated laterin an operation of the authors for the repair of a cheek defect. The flap may be lined with skin by grafting the under surface SURGERY OF THE EXTERNAL NOSE 449 either with OlHer-Thiersch, or with whole-thickness grafts, by theopen or by the buried methods, and allowing healing and shrinkage totake place before the flap is transplanted. Reconstruction of the Framework of the Nose There are two methods of making a framework for the nose. Inone we make use of inorganic jnaterials, which may he removable, or maybe buried. Prosthetic apparatus has already been considered, but Imight again say that the use of buried inorganic supports is certain instances removable supports may be considered advanta-. \ Fig. 481.—Operation for the reconstruction of the nose, conlinued.—A flap with itspedicle toward the elbow is raised from the anterior surface of the arm, and is sutured intothe forehead defect, and covers the raw surface of the turned down flap. The arm issecured, and after lo to 14 days the pedicle is cut and the nose is shaped. geous where there is a curtain of skin which covers the defect, but asa general rule the framework of the nose should be made of organicmaterial. In the second we make use of organic materials. Periosteum aloneincluded in the flap from the forehead (Oilier, 1864) for the formationof a framework is said to be satisfactory in certain cases, as bone maybe formed (if bone spicules are detached with the periosteum), butwhen transplanted free, my experience, experimental as well as clinical,has been that bone is never formed and that consequently periosteumis of little use in the formation of a support. 29 450 P
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgeryplastic, booky
