Fig. 266. Fig. 267. Fig. 268.
Israel Method.
Bardenheuer Method.—Bardenheuer has given this subject a great deal of attention, and advocates the use of the skin of the forehead for closing these buccal or oral defects. The skin of the forehead is without hair, is well nourished, and has little adipose tissue underlying it, facts that make it especially useful for these operations. The skin surface he turns into the mouth cavity, while the outer or raw surface is covered with a pedunculated skin flap taken from the region of the intramaxillary region.
The secondary wounds of the forehead and below the jaw should be covered with Thiersch grafts at the same sitting.
The best cosmetic results are obtained by correcting the entire defect at one sitting, as the subsequent contraction of the flaps do not allow of it in successive operations.
The apposition of the raw surfaces of the flap from the forehead and that of the cheek or chin greatly increases their vitality and overcomes markedly the cicatricial contraction.
The pedicle of the forehead flap is cut apart about the fourteenth day and replaced.
In the case depicted in [Fig. 269] a large portion of the cheek and the whole upper and a part of the lower lip had to be removed. A large flap taken from the forehead that turned into the defect (see [Fig. 270]), and a flap taken from the intramaxillary region, were brought over the major and lower portion of its raw and outer surface.