The flap is allowed to remain free at its base until contraction and cicatrization have been established, when the subseptum and wings are made.
The position of the arm and the attached flap at the root of the nose is shown in [Fig. 351].
He advises, when possible, to dissect up a flap of the cartilage of the old septum, letting it adhere at its lower border and turning it from below upward with the skin which covers it to form the subseptum. This will help to hold up the point of the nose firmly (an important matter because it is at this point that all noses constructed of skin flaps alone sink down for the want of suitable prop of tissue).
This cartilaginous flap he held in place with two pins thrust through the latter and the skin flap proper, and held them in place with a figure twist of silk. He removed the needles about the sixth day.
Fig. 351.—Fabrizi Method.
Steinthal Method.—This authority made the flap for the nose from the skin over the sternum, proceeding as follows:
“From the sternum I cut a flap of skin and periosteum in the form of a tongue whose lower base was five centimeters wide, and the summit forming the pedicle three centimeters wide; its length was twelve centimeters.
“I could have taken away with this flap some of the costal cartilage to utilize in making the wings of the new nose.