Plastic surgery; its principles and practice . achea. I have found it a good procedure in largedefects to implant cartilage parallel to the defect, and fairly close to it oneach side. Then, after a number of months, I raise a rectangular lateralflap on each side with the pedicle close to the margin of the defect,and turn over these flaps, including the cartilage, skin side inward, andsuture them in the midline. The raw surface of the prepared flapsand the defects from which they have been raised, are covered with apedunculated flap of skin. If the defect is large, it is better to waituntil the
Plastic surgery; its principles and practice . achea. I have found it a good procedure in largedefects to implant cartilage parallel to the defect, and fairly close to it oneach side. Then, after a number of months, I raise a rectangular lateralflap on each side with the pedicle close to the margin of the defect,and turn over these flaps, including the cartilage, skin side inward, andsuture them in the midline. The raw surface of the prepared flapsand the defects from which they have been raised, are covered with apedunculated flap of skin. If the defect is large, it is better to waituntil the new tube is completed before connecting it with the tracheaabove and below. If the thyroid cartilage is destroyed, an effort shouldbe made to shape the cartilaginous rib which is to be used in repairing it,before it is implanted. My experience has been that it is difficult tomaintain the cartilage in the V-shape, but this form may be again regainedif the cartilage ends can be secured (at the time of final transplantation) 6i8 PLASTIC SURGERY. I 2 Pig. 715.—Method of reconstructing a gap in the trachea.—i. The dark lines indicatethe incisions through which the pieces of cartilaginous rib were implanted parallel to thedefect. The dotted lines indicate the location of the notched cartilage. The perichon-drium is outward. The inserts show the method of notching the cartilage in order to giveit more flexibility. More than one piece of cartilage may be implanted on each side ifnecessary. 2. The dark lines indicate the flaps with their bases toward the midline. Theinsert shows the flap turned in and sutured, the edge AB to the edge AB. The raw sur-face may be grafted, but a pedunculated flap is preferable.
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