Sedillot Method.
Küster-Israel Method.—A flap was taken from the arm by the Italian method, which was sutured to the remains of the old nose so that its raw surface looked upward, not downward, as in the ordinary case.
The flap was made sufficiently large to permit of building the wings and subseptum. After it had healed into place the pedicle was cut, and a frontal flap was cut from the forehead to cover it.
An unusually large flap was required to do this, since it had to overcome the greater curvature already given and added to by the arm flap, necessitating an extensive secondary wound.
The reverse order of procedure would be the more advisable for this reason, and is resorted to by the following:
Berger Method.—This surgeon makes the lining flap from the forehead. The secondary wound is at once closed. A flap is then made from the arm by the Italian method, and brought into place before the one just made. It should be of sufficient size to allow of building the base of the nose, which is done not later than three weeks after the pedicle of the arm flap is severed, which may be done at any time between the eighth and the twelfth day.
All the precautions are used as already given in the description of the Italian method. The arm is held in the position shown in [Fig. 365].
Berger sutures the arm wound before bringing the flap into place upon the face to overcome the discomfort of suppuration to the patient.
The apparatus is fixed definitely after the patient has recovered from the anesthetic. Great care is exercised to prevent coryza from exposure. Dressings are made twice daily.