Eight days later minor operations are performed to reduce the exuberant portions of the side flaps.
Berger Method.—This author makes a flap of the skin above the border of the nose, which he turns down, raw surface outward, upon which he immediately brings a flap from the arm. The object of the lining is to give stability to the base of the new nose as well as to prevent curling and contraction of the rims of the nostrils.
Bayer-Payr Method.—Two flaps two and a half centimeters wide are cut from the nasolabial furrow, extending down to the lower border of the inferior maxillary bone, as shown in [Fig. 412].
The flaps are dissected up and brought forward and upward, their raw surfaces meeting in the median line, where they are sutured upon one another to the extent of three centimeters, as shown in [Fig. 413].
The nasolabial wounds are brought together by suture except for a small triangular space near each pedicle, which are allowed to heal by granulation.
The superior borders of the flaps were then united by suture to the freshened margins of the nose, which have been prepared as shown in the illustration.
The septal ends of the two flaps are likewise sutured to the stump of the old septum.
The raw or outer surfaces of the flaps are to be covered with Thiersch grafts when ready for them, though this may not be necessary with small flaps.
The pedicles of the flaps are not cut until the end of the fourth week, when the fresh ends may be sutured to freshened surfaces of the wings made to receive them.