Plastic and cosmetic surgery

by Frederick Strange Kolle

Fig. 345. Fig. 346.

Maisonneuve Method.

The Italian Method

In this classification of total rhinoplasty the skin flap is taken from another part of the body and not from the face. The integument of the arm is usually employed, the pedicle remaining intact until the flap has healed into place.

The method has been accredited to the Italian author-surgeon Tagliacozzi, but it was practiced long before his time; yet he was the first to fully describe the steps of the successful operation. It has been referred to quite fully under skin grafting.

The flap having an attached pedicle is cut from the entire thickness of the skin of the arm. The free end of the flap is sutured to the freshened borders of the old nose, and the arm is held in place until union has been established, when the pedicle is cut. There are no special advantages in this method, since the outcome is no better than that obtained with the Indian method; at best the result is merely the curtain of skin covering the defect, with the one thing in its favor—the avoidance of the frontal scar. Against this is the great discomfort the patient must suffer in having his arm retained in the necessary position to prevent movement and strain on the flap, to which may be added the danger of embolism occasioned by freeing the arm at the time the pedicle is cut. There is also difficulty of properly dressing the wounds, owing to the constrained position which consequently invite sepsis and imperfect healing. Hence, for total rhinoplasty, this method may be termed unsatisfactory; yet for certain partial rhinoplastic results it supersedes all other methods, as will be hereinafter shown.

To make the flap a pattern is laid upon the skin, from which it is to be made; it should be one third larger than the actual size of flap needed, to allow for contraction. The incisions should go through the entire thickness of the skin, leaving an attachment or pedicle, what in this case would be the part of the flap intended for the base of the nose, and directly opposite to those described heretofore.

The flap may be sutured in place immediately after the cutting, or it may be allowed to remain upon the arm until contraction has taken place in the flap, or the flap may first be modeled into nose shape and then sutured upon the freshened margins of the old nose.

The arm must in any of these methods be held in place during the days required to have the flap heal or unite with the facial tissue. The various operators have devised means to accomplish this. There is the linen network of bandages of Tagliacozzi, the harness of Berger, the starched linen and book-board affair of Sedillot, the one-piece suit of Lalenzowski, the leather sleeve and helmet of Graefe and Delpech and many others.