The requirement is that of support, whether it be organic or inorganic, and these methods will be considered presently. =Volkmann Method.=—This surgeon fashioned the frontal flap as shown in Fig. 354. This resulted in leaving a triangle of skin at the root of the nose, which he dissected up, down, to and inclusive of the periosteum, and turned downward so that its raw surface faced upward, as in Fig. 355. The flap was sutured into place to retain it. The frontal flap was brought down, so that the two raw surfaces came together. This method overcame the contraction of the flap over the nasal bridge or superior third of the new nose, and an excellent adhesion of that part of the flap to the denuded bone and flap resulted, but the same faults about the base were not mitigated. [Illustration: FIG. 354. FIG. 355. VOLKMANN METHOD.] =Keegan Method.=—The frontal flap method of Keegan has been referred to. For the lining of the upper nose he cuts two flaps from the skin above the old nasal orifice, as shown in Fig. 356, which he turns down, raw surfaces out. This gave a lining to either side of the median line; the skin remaining intact between the two flaps gave additional prominence and support to the upper third of the new nose. [Illustration: FIG. 356.—KEEGAN METHOD.] =Verneuil Method.=—Contrariwise to the methods just given, Verneuil, after cutting out the frontal flap, cuts the flap from the remaining sides of the old nose somewhat involving the skin of the cheeks, as in Fig. 357. This done, the frontal flap is simply turned down, raw surface out, and the cheek flaps are slid over it, bringing the raw surfaces together. The inner borders of the flaps were sutured in the median line, as shown in Fig. 358. The base of the nose is made from the frontal flap by any of the methods already given. [Illustration: FIG. 357. FIG. 358. VERNEUIL METHOD.] =Thiersch Method.=—The frontal flap is cut from the skin of the forehead in the shape shown in Fig. 359. Then two quadrilateral flaps are raised from the cheeks, as also illustrated. These are made wide enough that, when they were brought together, their inner borders could be made to face each other. In this position they were sutured along the median line, so as to give a double-gun-barrel form to the nose, with a septal wall between. From the lower border the nostrils were formed, giving to the new nose a normal appearance, the continuous septum curving downward to form the subseptum, the whole being sutured to the remains of the old nose. The frontal flap was now brought down over it, the raw surfaces facing each other, and sutured in place, as shown in Fig. 360. Later, Thiersch replanted the sides of the nose, to give it better contour, and attained a very satisfactory result. The frontal wound was covered with skin grafts, but the cheek wounds were allowed to heal by granulation. The cicatrization of the latter was not sufficient to effect the lower eyelids nor the angles of the mouth.