The triangular wounds in the cheeks are by this sliding process obliterated, and their raw edges are sutured vertically, as shown in [Fig. 236].
Fig. 235. Fig. 236.
Bürow Method.
Von Langenbeck Method.—Von Langenbeck, contrary to the double-flap methods, uses only one flap, with a lateral pedicle from the anterior chin.
After a semilunar excision of the diseased area, he cuts obliquely downward upon the anterior chin, then rounds his incision and continues it along, just above the margin of the chin, gradually cutting upward until its extremity is obliquely opposite to the angle of the mouth, as in [Fig. 237].
The flap thus formed will be seen to have a pedicle at this point. It is dissected away from its mucous attachment and is rotated upward, jumping it over the triangular spur, which has also been mobilized by a sliding dissection.
The flap is sutured into position, as shown in [Fig. 238]. Unfortunately, the flap does not permit of lining the raw margin of the wound with mucous membrane turned outward from within, hence it is best to take sufficient of the mucous membrane from the cheeks to accomplish this, or the vermilion border of the upper lip may be carefully cut away from the lip at its outer sections just above the prolabial line, and elongated by stretching upon the raw surface of the under lip, to which it is sutured.
Fig. 237. Fig. 238.