It may be necessary to shorten the flap A in cases where a very prominent hook is to be corrected.
Fig. 484. Fig. 485.
Base of Nose After Excisions.
The free end of the flap A is now sutured with No. 4 sterilized twisted silk to the stump of the columna at B. Two stitches usually suffice (see [Fig. 485]). One or two sutures may also be taken across the angles of union of the alæ and the flap A. The inferior raw surface of each wing may be found to be too wide, owing to the presence of the thickened cartilage at this point of the wing. The skin and the mucous membrane are then carefully peeled away from the cartilage, and the latter cut away as high as possible, or a gutterlike incision is made along its edges as shown in C ([Fig. 485]), excising the elongated elliptical piece of tissue which includes the cartilage. The raw mucocutaneous edges of the wings are now brought together with a No. 1 twisted silk continuous suture, completing the operation.
An antiseptic powder is dusted over the parts operated on, and small gauze dressings are applied with the aid of strips of silk isinglass plaster. A small tampon of cotton, well dusted over with an antiseptic powder, is placed into each nostril.
The dressings are changed the second day, when the resultant swelling will have practically subsided. The sutures in the columna are removed the fourth day preferably, and those of the wings about the sixth day. Complete cicatrization follows in about ten days, when the patient can be discharged.
The following cases are given to show the types of cases thus far operated upon and to illustrate the results obtained:
