This flap should be made slightly larger than the defect, since it contracts somewhat immediately after excision.
It is sutured rim down to the freshened wound in the wing.
The secondary deformity of the ear is brought together by suture. The author has found that this cannot be readily done without puckering the rim when the line of excision is made convexly, and advises making it triangular instead. The defect of the nose should be freshened to the same form. The flap from the ear now becomes ideal, fits better, is more readily sutured in place. No sutures should, however, be made through the apex of this triangular flap to avoid gangrene at this frail point. Silk isinglass at this point acts as a splint. Dry aristol dressings are used.
Fig. 453.—König Method.
Kolle Method.—When the defect of the ala is elongated and involves only part of the rim, the author has taken a cutaneo-cartilaginous flap from the back of the ear.
The flap is cut vertically, and is made to include a strip of cartilage of about the size and form of the defect.
The flap is immediately sutured to the freshened defect and folded upon itself with the cartilage facing the inferior margin of the defect.
The flap thus employed exhibits an epidermal face, both inside and outside as well as at the rim of the wing.
A case in which this method was used is shown in the illustrations 454 and 455, in which the defect is shown in the former figure, and the result after the sutures were withdrawn on the sixth day in the latter.