Heuter Method.—The cheek flaps are cut from the cheeks, as shown in [Fig. 340], leaving intact a triangular piece of skin with the object of giving support to the new nose. The inner and upper borders of the two flaps were stitched to the rim of this triangle, and then along the median line. The flaps are not made to include the periosteum, as in Nélaton’s method. The results thus obtained are not equal to the latter’s procedure.
Fig. 340.—Heuter Method.
Bürow Method.—The cheek flaps are made as in [Fig. 341]. The projection intended for the subseptum is an elongated strip at the inferior border and inner angle of the left flap.
The shaded triangles at either extremity of the outer incisions show the removal of the skin at these points, to facilitate sliding of the flaps, adding, however, to the extent of cicatricial contraction upon final healing, with the resultant flattening of the new nose. The lobular prominence takes an upward position eventually, and altogether the extensive secondary wounds and the effect of their behavior does not warrant the use of this method.
Fig. 341.—Bürow Method.
Szymanowski Method.—His method is an improvement on that of Bürow. The flaps, inclusive of considerable cellular tissue, are fashioned in [Fig. 342], except under the two narrow extension flaps, which are to be utilized in building up the subseptum. Their raw surfaces are sutured together with silk. The flaps are united along the median line.
If the tissue from the cheeks do not permit of free sliding forward of the flaps, further incisions shown by the dotted lines over each malar prominence are made. The skin of the shaded irregular areas on either side is removed, as in the Bürow method.
