Fig. 337.—Von Langenbeck Method.
Szymanowski Method.—The flap is formed as shown in [Fig. 338], the pedicle having its upper incision just below the end of the right eyebrow and the lower below the inner canthus on a line with the first, giving it an oblique position.
Just below the curvature of the basal incision two short incisions are made on either side into the forehead tissue with a view of rendering more flexible the skin to be utilized in correcting the secondary wound. The margin of the old nose is freshened.
Fig. 338.—Szymanowski Method.
Labat, Blasius, Linhart Method.—These operators performed their operations in two sittings. In the first the incisions were so made at the base as to permit of that part of the flap intended for the rim of the nares to be tucked in, as it were, where these two triangular little folds were held in place by silk suture. When the parts had become thoroughly united, or at the second sitting, the entire flap was cut away and brought into place for the new nose. The object of this procedure was to give body to the wings of the nose and to overcome the consequent curling and contraction of the skin so commonly found with the single sitting operation.
This step marked the first advancement toward attaining much more successful results in total rhinoplasty by using skin-lined flaps, which not only added to the better nutriment to the part, but also gave support and firmness to the new organ.