Keegan Method.—The frontal flap method of Keegan has been referred to. For the lining of the upper nose he cuts two flaps from the skin above the old nasal orifice, as shown in [Fig. 356], which he turns down, raw surfaces out. This gave a lining to either side of the median line; the skin remaining intact between the two flaps gave additional prominence and support to the upper third of the new nose.
Fig. 356.—Keegan Method.
Verneuil Method.—Contrariwise to the methods just given, Verneuil, after cutting out the frontal flap, cuts the flap from the remaining sides of the old nose somewhat involving the skin of the cheeks, as in [Fig. 357]. This done, the frontal flap is simply turned down, raw surface out, and the cheek flaps are slid over it, bringing the raw surfaces together. The inner borders of the flaps were sutured in the median line, as shown in [Fig. 358]. The base of the nose is made from the frontal flap by any of the methods already given.
Fig. 357. Fig. 358.
Verneuil Method.
Thiersch Method.—The frontal flap is cut from the skin of the forehead in the shape shown in [Fig. 359]. Then two quadrilateral flaps are raised from the cheeks, as also illustrated. These are made wide enough that, when they were brought together, their inner borders could be made to face each other. In this position they were sutured along the median line, so as to give a double-gun-barrel form to the nose, with a septal wall between.
From the lower border the nostrils were formed, giving to the new nose a normal appearance, the continuous septum curving downward to form the subseptum, the whole being sutured to the remains of the old nose.