Bayer Method.—Bayer has successfully utilized a large flap from the mucous membrane of the palate and covered it externally with a flap of skin taken from the submaxillary region.
Kraske Method.—Kraske forms the flap to be turned into the defect of the tissue immediately surrounding it, as shown in [Fig. 264]. This flap may heal into position, even though its pedicle is made up only of subcutaneous tissue, according to Gersuny.
The epidermal surface of such flap is made to form the inner or mucous surface of the repaired cheek (see [Fig. 265]), while its external surface and the secondary wound are covered with Thiersch grafts, at one and the same sitting.
The only difficulty experienced in the case with men is that the bearded surface of this inturned flap offers considerable discomfort to the patient, although in the majority of cases the skin thus inverted soon takes on the appearance of the mucosa, the objectionable hairs falling out and the hair follicles becoming obliterated.
Fig. 264. Fig. 265.
Kraske Method.
Israel Method.—To overcome the above objection Israel makes his flaps from the skin of the side of the neck, the flap being elongated and attached at its upper end, as in [Fig. 266].
This flap he turns upward into the defects with its epidermal surface facing inward and sutures it into place, as shown in [Fig. 267], leaving the outer surface to granulate over and thicken on the sutured margins to heal into place. This requires from fourteen to seventeen days, when the pedicle is severed and the lower or freed portion of the flap is brought forward. The granulation of the entire surface is scraped off and the free end of the flap is turned over upon itself, as it were, and its margins sutured to the descended skin margin, as in [Fig. 268].