The pedicle is cut under local cocain anesthesia.
To make the subseptum and wings of the nose, the base of the flap is cut into three sections. The posterior surface is freshened and the parts are folded upon themselves and sutured into position.
Instead of employing rubber tubes, he resorts to a specially devised apparatus to retain two metal tubes in the nares, and at the same time make gentle pressure to the sides of the nose to mitigate the columna contraction. The latter is planted into a V-shaped incision made into the tissue of the upper lip at the proper place of attachment. The subseptum may be lined with a flap of mucosa dissected up from the floor of the inner nose.
For the wings of the nose, such tissue as may be of service to give them stability and structure is taken from the remains of the old nose.
Fig. 365.—Berger Method.
The apparatus just mentioned and shown in [Fig. 366] is used from the very first day until total cicatrization has taken place, and even for a longer period to aid in shaping the entire nose and the tendency to collapse has been overcome.
Fig. 366.—Berger Retention Apparatus.
Szymanowski Method.—A frontal flap, divided along the median line and shaped as outlined in [Fig. 367], is made from the forehead.