A manual of operative surgery . -sible, a small thin flap shouldbe formed from the skin ofthe root of the nose. Thisflap should be quadrilateral,with the base or attached sidedownwards. It should be de-tached and turned downwards{a, Fig. 245), so that its rawsurface is directed forwards. This flap can only be usedwhen the skin over the nasal bones is sound and healthy. Itserves to increase the solidity of the new nose, and to form afurther attachment for the frontal flap. Third Stage.—The frontal flap is made. A model of thenew organ should have been already fashioned in thin gutta-percha or p
A manual of operative surgery . -sible, a small thin flap shouldbe formed from the skin ofthe root of the nose. Thisflap should be quadrilateral,with the base or attached sidedownwards. It should be de-tached and turned downwards{a, Fig. 245), so that its rawsurface is directed forwards. This flap can only be usedwhen the skin over the nasal bones is sound and healthy. Itserves to increase the solidity of the new nose, and to form afurther attachment for the frontal flap. Third Stage.—The frontal flap is made. A model of thenew organ should have been already fashioned in thin gutta-percha or plaster. This model when flattened out is laid uponthe forehead, and, guided by its outline, the flap is marked flap should be about a third larger than the area of thedefect, or in marking it out in ink upon the forehead a quarterof an inch may be allowed on each side of the prepared tissue must be provided to allow for the alae and upper extremity of the flap will reach about to the border of. FIG. 245.—RHINOPLASTY. a, Nasal flap ; b, Pedicle of frontal flap ;c, Frontal flap. 120 OPERATIONS ON HEAD AND NECK [part hi the scalp. If the forehead be low the flap will encroach upon thehair. The apex or narrow part of the flap will be, of course, at theroot of the nose. The flap should include all the tissues downto the pericranium, which must not be disturbed. It must bedissected up boldly and freely. The formation of the pedicle or apex of the flap isimportant. It is well that the incision marking one side of the flapshould be continued downwards into the recently freshenedarea (b, Fig. 245). By means of this incision the pedicle can be lifted from thebones, and will contain the supratrochlear artery of one is impossible that the pedicle can be so made as to includethe arteries of the two sides ; and if the plan just described beadopted, the compression of the artery by the torsion of the pedicleis reduced to a minimum. The side selecte
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Keywords: ., bookcentury1900, booksub, booksubjectsurgicalproceduresoperative
