Two triangular flaps are then raised from either side, and including the angle of the nose as shown. The divided frontal flap is now brought down in such manner that their raw surfaces meet, thus forming a vertical septum. The margins are united by suture, and the lower ends are fixed into a wound made for the purpose at the base of the nose, as shown in [Fig. 368], to form the new subseptum.
The lateral triangular flaps are dissected up so that they can be readily slid forward toward the median line. Their inner freshened margins are sutured to the raw edge of the septum just made, and to themselves. The objection here is that there is a liability of considerable contraction of these lateral flaps, with a tendency to fall in and drag with them the new septum; and again, in total restorations, the upper third of the nose is only partially covered, and necessitates later upbuilding. The author finds difficulty in making the four margins thus brought together unite evenly throughout, and that a vertical contraction is caused by the cicatrization of the median marginal wound.
Fig. 367.—First Step.
Fig. 368.—Disposition of frontal flaps.
Szymanowski Method.
Goris Method.—The operation is performed as follows, having given very good results, according to the author:
I. The frontal flap is divided lengthwise so that its raw surfaces face each other. The resulting fold, representing the bridge of the nose, is held in place by catgut suture.
II. The skin to make the wings of the nose is folded in, as in the Langenbeck method.
III. A flap, half the thickness of the upper lip is brought up to form the new subseptum.