Plastic and cosmetic surgery

by Frederick Strange Kolle

The pedicle of the flap is cut close to the arm at the end of two weeks. The subseptum may be made at once if the flap shows good nutrition, as evidenced by marked bleeding at the time of cutting away the bridge tissue.

Restoration of the Alæ

The method of restoration of the wing or wings of the nose depends largely upon the extent of the tissue loss.

The use of the Hindu method is not advisable, since the flap must be made with a long pedicle, which involves the making of a large wound and predisposes to consequent large cicatrices, although many surgeons have resorted to the method. The author does not see any advantage with this method, even if the loss of tissue about the lobule is great.

The best results, both as to the primary and secondary wounds, are those obtained with the Italian method, and in extensive cases the use of a combined flap, wherein the lining flap is taken from the nasolabial furrow or just above it. This leaves a linear scar that does not disfigure the face, and assures of better contour than when a single integumentary flap is employed which, as has been so frequently mentioned, is liable to curl inward and contract in an upward direction, adding little to the area of lost tissue.

The ideal operations are those which include cartilaginous supports, which may be obtained from about the border of the deformity or from some remote place, as of the ear. The surgeon is hardly justified to use the remaining healthy tissue of the nose, unless the case is such that the secondary wound can be corrected, so as not to add scars to the face.

Small defects can be easily corrected by sliding flaps taken from the vicinity of the defect, whether they include cartilage or not, and by granulation or dissection and approximation of the skin, the secondary wound may be entirely closed. It is remarkable how little linear scars show about the nose when the lips of the wounds have been neatly brought together.

The author advocates the use of the continuous silk suture for this purpose, since it fulfills both the object of suture and splint and overcomes the corrugating effect, so often found with interrupted sutures; furthermore, a continuous suture is more easily withdrawn, and there is no danger of wounding the skin on removal, and the discomfort to the patient is greatly reduced.