The Indian or Hindu Method, in which the flap is made from the forehead.
The French Method, in which the flap is made from the tissue about the borders of the deformity.
The Italian Method, in which the flap is taken from some distant member or part of the body.
Furthermore, there are the combined methods of one or the other in which inverted skin flaps are used, or those lined with an osseous and cartilaginous support, and in some rare and rather unsuccessful cases by metallic supports.
The Indian or Hindu Method
The method of rebuilding the nose by taking one or two flaps from the forehead dates back to the Koomas, from whom the art of rhinoplasty has come down to the present time, all of the methods of to-day involving the utilization of the pedunculated flap being a result of their early surgical ingenuity.
Originally, their operation consisted of cutting an oval flap, having its pedicle as the root of the nose, and extending over the forehead, and upward vertically into the hair line. The flap thus made was dissected away from the bone and brought down by twisting it to the extent of a hundred and eighty degrees on its pedicle in front of the nasal deformity, the edges of which had been prepared to receive it. To hold the flap in position they resorted to some kind of clay, sutures being unknown to them.
The pedicle was cut after the flap had thoroughly united to the freshened borders of the deformed nose.
The steps of the operation as performed by them are shown in [Figs. 314, 315, and 316].