The object of the arrangement was to give a rimlike lining to the two nostrils, the raw surfaces of the outer points being brought into contact with each other. He also hollowed out a groove at the root of the nose, to better accommodate the pedicle when twisted. The steps are shown in Figs. 319 to 321. The pedicle was later severed when the conditions warranted it. [Illustration: FIG. 318. FIG. 319. FIG. 320. FIG. 321. DELPECH METHOD.] =Method of Lisfranc.=—Lisfranc conceived the idea that if he carried down the one incision for the flap at the root of the nose somewhat lower than the other he would overcome some of the torsion at this point. This he consequently did, making the left incision half an inch lower than the right. The lateral incisions ascend at an angle of forty-five degrees (see Fig. 322), uniting in rectangular form at the scalp line, as shown, the rectangle of skin being utilized to make the subseptum. Instead of sutures he dissected up the old nasal borders and slid the flap borders into this groovelike arrangement, holding it in place with the aid of sticking plasters. With the above method the pedicle was allowed to remain intact. Fig. 323 shows the position of the flap, and the treatment of the subseptal section. [Illustration: FIG. 322. FIG. 323. LISFRANC METHOD.] =Labat Method.=—Labat uses a frontal flap shaped as in Fig. 324. The left bordering incision is carried down one half inch below the point of beginning on the right and carried downward in such manner that its lower point lies in a line with that of the right above it. The object of this was to overcome torsion, and, where obtainable, the small triangle of healthy tissue at the root of the nose, as shown in the illustration, was dissected off from above downward, and turned downward with the cutaneous side facing the nasal chasm and its dissected side facing that of the flap. He avoids injury to the angular artery, as should be done in all cases. The pedicle was replaced at a second operation. [Illustration: FIG. 324.—LABAT METHOD.] =Keegan Method.=—Utilized a flap, shaped as in Fig. 325. The pedicle occupies the internal angle of the eye, care being taken to preserve the angular artery. The flap is mapped out obliquely, not perpendicularly. To get the best results he advises pasting a paper model upon the forehead to guide the operator in making the flap, which includes all the tissue down to the periosteum. Horsehair sutures are employed to approximate the parts accurately. The pedicle is divided in about twenty days, and a wedge-shaped piece of skin is excised at the root of the nose to prevent the tuberosity at this point of the new nose, so commonly observed with Indian-flap methods. [Illustration: FIG. 325.—KEEGAN METHOD.]