Restoration of Subseptum
For the correction of this defect various methods are given, and all of these must be modified more or less, to meet the requirements or extent of lost tissue. In some cases the entire subseptum is absent, while in others there is more or less of a stump remaining. Again in some, the subseptum required is unusually wide and in others quite narrow.
While a number of surgeons prefer making the flap to restore it from part or the whole thickness of the upper lip, as will be shown, the author believes the best results are to be obtained with the Italian flap method, if there be great loss of tissue, or to attempt to restore smaller defects with cartilage-supported nonpedunculated flaps taken from back of the ear, as heretofore described, or the cartilage to be used as a support may be taken from the nasal septum itself, having its pedicle posteriorly.
This strip of cartilage is brought downward, freed at either side from its mucosal attachment, and the skin flap to be used is then made wide enough to be sutured to the inferior mucosa margins as well as to the skin of the lobule.
The method of taking a sliding flap from the healthy skin of the nose is not advisable, because of the resultant disfigurement.
The tissue of the lip, on the other hand, can be used, since the secondary wound can be readily drawn together, leaving only a linear scar. In men, this may be hidden by the mustache.
When the Italian method is used, the method referred to in restoration of the lobule is to be followed.
Blandin Method.—The flap is taken vertically from the entire thickness of the upper lip, as shown in [Fig. 458], having its pedicle at the base of the nose.
This strip of tissue is turned upward, mucosa outward, and its freshened free end is sutured to the raw surface of the lobule.