Van Helmont is said to have made a nose for a gentleman from the skin of the buttocks of a street porter.
Bünger, of Marburg, in 1822 made a total nose from the anterior thigh.
Several surgeons later than the above date have successfully restored parts of the nose by transplanting skin flaps from remote parts of the body, the method involved being practically what is now accomplished by the so-called skin-grafting methods of nonpedunculated flaps heretofore referred to.
While for small defects such procedure has proven quite successful, the employment of large flaps for nasal reconstruction has been exceedingly discouraging, although the author advises trying transplanting of such flaps when the patient hesitates giving up sufficient facial skin for rhinoplastic purposes for fear of disfiguring scars, or when there are untoward reasons.
In such event there is only the secondary wound to be considered apart from the death of the flap, and the minor operation about the remains of the nasal organ to permit of the fixation of the latter.
A thorough and practical knowledge of skin grafting is of the greatest necessity to the surgeon, because he must be ready to cope with any emergency in such cases, and thus be able to save a flap graft from death or partial gangrene, when he would otherwise fail.
TOTAL RHINOPLASTY
Pedunculated Flap Method
The most practical and safe methods of rebuilding the nasal organ have been those in which flaps having nutrient pedicles have been employed, whether these flaps be taken from the skin of the forehead, cheek, or both. These procedures are autoplasties, and may be grouped according to their peculiar differentiation into three classes, as follows: