The frontal flap should be made long enough to permit of building a subseptum and the nostrils.
Krause Method.—This frontal cutaneo-osteo-periostitic flap is made according to the method of König.
After turning down the flap it was covered with a nonpedunculated skin flap taken from the upper part of the arm by transplanting after its subcutaneous fatty tissue had been removed. (See [Fig. 379].)
This method necessitates a long-continued dressing of the forehead before the pedicle is cut, because of the needed nutrition to make the two flaps heal upon each other.
After union has been established the sides of the transplanted flaps are raised by dissection, as shown in [Fig. 380], to expose the bone plate of the frontal flap. A median strip is left intact.
With a fine saw the bony plate is cut into three sections, making the narrowest the median.
The margins of the old nose are now freshened, and the combined flap is sutured along the sides, preserving what tissue the surgeon can use to add support to the nose, which is done by dissection and turning or folding, as heretofore described.
The lower or forehead flap is sutured to the soft parts of the old nose, and the transplanted lateral margins to the marginal skin of the cheeks, giving to the nose the appearance as shown in [Fig. 381].
At a later period the pedicle is cut and the wound that cannot, at this time, be overcome by sliding of the adjacent skin, is covered by skin grafting.
