Fig. 382.—First step.
Fig. 383.—Making bony support to flap.
Nélaton Method.
There is some difficulty associated with the making of the flap, which ends at the superior border of the frontal, leaving the pedicle composed only of skin.
The flap is now turned down, exposing its raw surface. The bony plate is sawed through at the median line, as shown in [Fig. 384], and the skin of the flap is also divided along this line, giving two partly bone-lined flaps.
The two flaps are now rotated downward before the lost nose, so that their raw surfaces face inward, and in this position they are sutured along the median line and the sides, as shown in [Fig. 385].
The method gives an angular dorsum of satisfactory consistency to the new nose, but furnishes a serious drawback, in that the cicatrization along the median line is liable to affect the shape of the organ and leaves a prominent scar line. The use of two small pedicles is another objection in that the danger of gangrene is greater as the nourishment to each flap is less.
Fig. 384.—Cutting through bony plate.
Fig. 385.—Disposition of frontal flap.