Lectures on the operations of surgery : and on diseases and accidents requiring operations . mly andneatly in apposition, and thereby prevent the oozing of upon it the twisted suture is the best to insure union bythe first intention. We will suppose that only the cartilaginous part of the nose islost. The patient comes in this predicament, and wishes to havethe deformity removed by operation. You ought to do it; there isno danger; and it is generally a very satisfactory proceeding. Hav-ing looked at the case, and determined on the size of the flap, youpare the edges, make a deep i
Lectures on the operations of surgery : and on diseases and accidents requiring operations . mly andneatly in apposition, and thereby prevent the oozing of upon it the twisted suture is the best to insure union bythe first intention. We will suppose that only the cartilaginous part of the nose islost. The patient comes in this predicament, and wishes to havethe deformity removed by operation. You ought to do it; there isno danger; and it is generally a very satisfactory proceeding. Hav-ing looked at the case, and determined on the size of the flap, youpare the edges, make a deep incision all round, then with the hookedforceps take up the portion and detach it, thus forming a deep sul-cus, into which to insert the edges of the flap. You may make theflap of the form here represented—the one which the Indians re-commend, and which was adopted by Mr. Carpue; or you maymake the point of the nose first, and after that has adhered makethe column. This is the mode which I have latterly make a pattern, say of soft white leather, and with Indian ink Fig. AFFECTIONS OF THE NOSE. 171 draw a mark around on the skin, to show the shape and size of theflap. You bring the pattern well down to the root of the nose, andthen make an incision at once down to the pericranium: there isno use in scratching the parts bit by bit. You take down the flapcomposed of skin and the occipito-frontalis, leaving it at its tempo-rary attachment betwixt the superciliary edges as thick as you pos-sibly can, and cutting a little lower down on one side than on theother, to allow it to be turned round cleverly. The bleeding atthis part and also of the flap having ceased, you turn the flap round,and stitch it by two or three points of interrupted suture on eachside. It now looks, anyhow, very awkward indeed. The flap issoft and movable, it is puffed up by the expirations of the patient,and it has been asked, How is this to be supported? It has beenproposed to put in an artif
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