Fig. 445. Fig. 446.
Von Hacker Method.
Kolle Method.—The author dissects away the flap E, A, D when part of the mucosa and cartilaginous tissue remains, and where there is a loss, total or partial, of the alar rima, the transverse incision E being made as long as required to overcome the defect by sliding, as in [Fig. 447].
The latter flap is freshened at its inferior border along the line D, and a second or bordering flap of sufficient width to line and face the nostril is taken up from the upper lip, skin only, as shown in area C.
The lateral or upper flap is now slid down to slightly overcome the loss of tissue and the flap C is brought upward by twisting slightly on its pedicle and sutured in place, as shown in [Fig. 448].
The secondary wound lying between the lines E and E’, occasioned by the sliding downward and leaving the triangular defect F, is allowed to heal by granulation. The lateral flap is fixed along the line A.
Usually the pedicle of flap C need not be cut, as it adjusts itself under primary union.
The secondary lip wound is closed at once by suture. The author has also used the inverted V incision of Dieffenbach, including the cartilage or part thereof that remains above the defect, and has moved this flap downward, suturing in Y fashion with good results.
