FIG. 376.—Disposition of frontal and skin-grafted flap. SCHIMMELBUSCH METHOD.] =Helferich Method.=—A lining flap is made, according to the French method, from the one cheek, which is dissected up and turned over to bridge most of the loss of nasal tissue, and sutured to the opposite freshened margin, as showed in Fig. 377. A frontal flap, as outlined in the same illustration, is now cut from the forehead, leaving a pedicle as shown, and containing a section of bone at its median line. This is rotated downward and into place, and sutured along the same margin to which the genian flap is fixed, as shown in Fig. 378. When the frontal and genian flaps have become well united, the latter’s pedicle is cut when the freshened lateral margin of the frontal flap is sutured into place. A subseptum is now made or deemed necessary by this surgeon. At a later period the pedicle of the frontal flap is cut, and fixed by suture and some cutting, to reduce the resultant prominence thereof. [Illustration: FIG. 377. FIG. 378. HELFERICH METHOD.] =Preidesberger Method.=—This author cuts away the skin surrounding the arch of the old nose, and turns this flap downward to form the lining to the flap made from the forehead made in the same manner as Helferich. The bone section is made in the median line, and is one centimeter wide and four long. The frontal flap should be made long enough to permit of building a subseptum and the nostrils. =Krause Method.=—This frontal cutaneo-osteo-periostitic flap is made according to the method of König. After turning down the flap it was covered with a nonpedunculated skin flap taken from the upper part of the arm by transplanting after its subcutaneous fatty tissue had been removed. (See Fig. 379.) This method necessitates a long-continued dressing of the forehead before the pedicle is cut, because of the needed nutrition to make the two flaps heal upon each other. After union has been established the sides of the transplanted flaps are raised by dissection, as shown in Fig. 380, to expose the bone plate of the frontal flap. A median strip is left intact. With a fine saw the bony plate is cut into three sections, making the narrowest the median. The margins of the old nose are now freshened, and the combined flap is sutured along the sides, preserving what tissue the surgeon can use to add support to the nose, which is done by dissection and turning or folding, as heretofore described. The lower or forehead flap is sutured to the soft parts of the old nose, and the transplanted lateral margins to the marginal skin of the cheeks, giving to the nose the appearance as shown in Fig. 381. At a later period the pedicle is cut and the wound that cannot, at this time, be overcome by sliding of the adjacent skin, is covered by skin grafting. [Illustration: FIG. 379.—First step. FIG. 380.—Second step. FIG. 381.—Third step. KRAUSE METHOD.]