The movable devices were a source of irritation and pressure, and could not overcome the consequent contraction of the flaps whether placed below a single flap or between two flaps, and the fixed protheses of whatever form or material caused so much pressure that gangrene resulted, and they had to be removed sooner or later.
Before the discovery of Gersuny, the author had many occasions to utilize such movable protheses in the correction of saddle noses. These were generally made of a silver shell, gutta percha, and later of decalcified bone, as advised by Senn. The former remained in place from six months to two and a half years, and then were thrown off or had to be removed because of irritation. The bone chips soon became absorbed, leaving the nose as before, or a thin median strip that became broken with the least violence, and then was absorbed.
In several cases where other surgeons had resorted to such protheses, the author was called upon at a later period to remove them.
While the immediate result is very gratifying, the ultimate result is worse than useless, since in the elimination of the foreign body the flap of the nose was married by cicatrices that added still further to the contraction and falling-in of the nose.
Periostitic Supports
Some other method had to be devised, and organic supports became known. These organic protheses were made of the tissue in the near vicinity of the flap, and at first formed a part thereof. The earlier method included only the periosteum; later bone and periosteum were added to the flap to give it shape and support, and lastly cartilage was employed for the purpose.
Of the methods employing only the periosteum, it may be said that what the surgeon expected of this membrane—namely, the springing up of bone cells—did not take place; at least, not to the extent desired. The very best to be attained was a thickening of flap in the membrane, but not sufficient to add necessary support to the nose.
Osteoperiostitic Supports
The inclusion of the periosteum-lined flap was soon abandoned, and recourse was had to such bone additions to the flaps as could be obtained from the vicinity of the nose.
The bone was removed with its periosteum, adherent or nonadherent to the flap, as will be shown by the methods described hereafter.