Von Hacker Method.—The frontal flap was cut in the ordinary Indian method, and of the shape shown in [Fig. 355]. The skin at either side of the median line was dissected up to within four millimeters, leaving a strip eight millimeters wide from the root of the nose to the distal or scalp end. The two loose lips of the flap were brought together at the anterior median line by a few sutures to keep them in place.
This was done to give freedom to the surgeon while he detached a strip made of the periosteum and bone chiseled from the frontal bone. At the root of the nose or below the pedicle the bone was not included to the extent that it would interfere with torsion of the flap, and yet sufficient to allow the raw bone surface to fall upon what remained of the bony bridge of the old nose.
Fig. 370.—Arrangement of frontal flap to allow of chiseling.
Fig. 371.—Making the osteoperiostitic support.
Fig. 372.—Bone-lined flap brought into position.
Von Hacker Method.
He utilizes pins driven into the bone to outline this bony section, as shown in [Fig. 370].