Rubber tubes of proper diameter for insertion into the nares should be at hand if required.
When all is ready the operator is to proceed quickly and accurately, never changing his prearranged idea of the operation. His assistants should be ready to control by torsion or pressure the bleeding occasioned by cutting, since it covers the field of operation and hinders rapid work.
The surgeon in making flaps should use the greatest gentleness in handling them to prevent pressure gangrene. His finger tips are far better than fixation forceps. Sharp tenaculi may be employed with gentle traction only. Never permit the use of serrated forceps in autoplasty.
In cutting, employ the rules laid down under the principles of plastic surgery, and in dressing flap operations such methods as have been heretofore described.
Dressing.—Do not be too hasty in dressing such wounds, as early interference often results in partial if not total loss of the flap.
The author has found that in flap operations blood dressing under perforated rubber tissue is best. This helps to give nutriment to the parts and permits of free removal of the dressings. Never apply the blood treatment on gauze, since the latter is liable to become hard and attached to the suture lines, requiring undue force for its removal.
Care of the Nares.—Remove all packing from the nares before fixing the lobular section of the flap, and have all bleeding controlled before suturing the part of the flap intended for the columna. Blood clots tend to pressure and infection. If nare tubes are used rather let them remain in place for some time than to drag them forth forcibly.
The interior nose and nares can be kept clean by gentle irrigation through them.
Number of Operations.—Instruct the patient as to the probable outcome of the operation, and advise him that more than two or three operations may be necessary to correct the deformity.