Two little triangular flaps of skin are dissected up, skin only, at D, E, C and H, G, C.
Next a rectangular flap, I, K, L, M, is dissected up from the cheek, as in [Fig. 452], including some areolar tissue.
The flap should be made sufficiently long, so that when folded over it will fit into the defect without tension, at the same time allowing for contraction.
This flap is sutured into the defect made by the making of the first flap, as shown.
The secondary wound of the cheek is brought together by suture, except for a small triangle near the pedicle to avoid its constriction.
Its raw surface is allowed to heal by granulation. The pedicle is severed in about fifteen days, and may be cut in triangular fashion to make it fit smoothly into the slight defect in the skin just posterior to it.
Fig. 450. Fig. 451. Fig. 452.
Von Hacker Method.
König Method.—In this novel method a flap somewhat of the form of the defect is taken from about the entire thickness of the rim of the ear, as shown in [Fig. 453].