This cartilaginous flap he held in place with two pins thrust through the latter and the skin flap proper, and held them in place with a figure twist of silk. He removed the needles about the sixth day. [Illustration: FIG. 351.—FABRIZI METHOD.] =Steinthal Method.=—This authority made the flap for the nose from the skin over the sternum, proceeding as follows: “From the sternum I cut a flap of skin and periosteum in the form of a tongue whose lower base was five centimeters wide, and the summit forming the pedicle three centimeters wide; its length was twelve centimeters. “I could have taken away with this flap some of the costal cartilage to utilize in making the wings of the new nose. “I dissected up this flap and closed the wound over the sternum with sutures. The flap was then stitched to the forearm by its base into an incision of appropriate length made near the radius. (See Fig. 352.) The arm was properly fastened in a plaster apparatus and the flap enveloped in a dressing of borated vaselin. The forearm was held in front of the breast, an attitude easily retained. Twelve days later I cut the pedicle. “I let a few days pass by, and then stitched the pedicle end of the flap to the root of the nose. A new plaster apparatus was put in a suitable position. The hand was placed on the forehead. “Ten days after, I detached the flap from the arm and reformed the nose with the flap, which hung down like an apron. It is necessary to have a flap sufficiently long to fold in for the nostrils. I used bronze aluminum wires for all the sutures.” The position of the hand while the flap was healing to the root of the old nose and the slight twist of the flap is shown in Fig. 353. [Illustration: FIG. 352. FIG. 353. STEINTHAL METHOD.] THE COMBINED FLAP METHOD To overcome the consequent cicatricial contraction and falling in of the flap used to make the new nose by either of the three grand methods given, various surgeons have resorted to lining the flap with skin flaps, bringing their raw surfaces together so that the nose actually received in this way an integumentary lining. While this had the tendency to thicken the new nose, it did not give the support necessary to it, especially at the lower third, and the lobule, at first quite satisfactory, resulted only in the appearance and form of a small tubercule of tissue, with a decided saddle effect above it. This combined method did overcome, however, the slow process of cicatrization, and its accompanying suppuration. The raw surfaces of the two flaps, if properly brought together, healed upon themselves readily, as has been referred to in the lining or doubling in of the basal sections to form the nostrils and subseptum. The method of lining the nasal flap in this manner is never sufficient to give a satisfactory result in total rhinoplastic cases, but may be of great service in restoring parts of the nose, as will be shown later.