The frontal flap was now brought down over it, the raw surfaces facing each other, and sutured in place, as shown in [Fig. 360]. Later, Thiersch replanted the sides of the nose, to give it better contour, and attained a very satisfactory result. The frontal wound was covered with skin grafts, but the cheek wounds were allowed to heal by granulation. The cicatrization of the latter was not sufficient to effect the lower eyelids nor the angles of the mouth.
Fig. 359. Fig. 360.
Thiersch Method.
Helferich Method.—His is an ingenious application of the French method. Both flaps are cut from the cheeks; the lining flap was made from the left and the covering one from the right cheek. The shape of the flaps is shown in [Fig. 361].
The lining flap is stitched along the freshened margin of the right side of the nose. The flap should be wide enough to give convexity to the nose, as shown in [Fig. 362].
The covering or right flap, cut much larger, is now slid over this. It should be cut amply large to cover the flap just sutured in place. It is sutured on both sides of the nose to hold it in place, also at the inferior margin. The nose is lightly packed with iodoform gauze.
The pedicle of the right flap was cut after two and a half weeks and brought into place across the root of the nose, and sutured in place to give better contour to the part after freshening the skin about the left side of the nose at this point. He does not make a subseptum, but thinks the inferior base of the nose of sufficient size to hide the absence thereof.
The subseptum could, however, be readily made from the upper lip, as will be shown later.