The cartilage is now thrust into the tunnel thus made, the thinned-down, notched-off section facing forward and lying toward the vertical incision.
The skin wound is sutured and a gentle compress is used to keep the cartilage in contact with the periosteum, which requires at least two months. A longer interval of time is advocated to give greater vitality to the cartilage.
The wound of the thorax is simply sutured and dressed as any surgical wound.
Final Operation.—The part cut is prepared as in the Hindu method. A lining for the frontal is made of such tissue as remains, and its freshened borders are sutured where possible, as shown in the last figure.
When this cannot be done, a flap may be taken from the arm, as already suggested, or a Krause nonpedunculated skin flap may be used, according to the methods given heretofore.
The epidermis is made to face inward. If either of these methods is used, the frontal lap is not brought down until healthy granulation has been established.
The frontal flap is made to include the periosteum, from which it is separated with a blunt instrument. The cartilaginous strip will be found to be attached to the periosteum.
The freed flap is now brought before the nasal defect and fitted into place. The cartilaginous strip should occupy the anterior median line.
The subseptal cartilage is bent inward and downward and the skin of the flap is sutured to it with catgut to form the subseptum, as shown in [Fig. 392].