The Italian flap may be taken from the arm or forearm, this surgeon preferring the forearm. The attached flap and position of the hand on the forehead where it is retained with an apparatus for the required time is shown in [Fig. 415].
The adherent Italian flap and its subseptal addition and the outlines for the lining flaps are shown in [Fig. 416].
The secondary nasogenian wounds reduced by suture and the flaps so obtained are shown in [Fig. 417]. The subseptal section of the Italian flap is raised to show the disposition of the flap ends to form the new septum. The raised flap is brought down and sutured to the raw edges of the two septal flaps covering the median cicatrix, its own cicatrices falling within the rim of the nostrils.
Fig. 415.—Attachment of flap from forearm.
Fig. 416.—Forearm flap in position and outline of lateral flaps.
Fig. 417.—Disposition of lateral flaps.
Ch. Nélaton Method.
This surgeon advises in less severe losses of tissue to do without lining the Italian flap, but to make the latter large enough to be able to fold in enough of its base sections to line the nostrils to the extent of the inferior line of the mucosa. The flap should be cut one fourth longer than the nasal deformity.
This procedure also overcomes to a great extent the shrinking of the nasal orifices.