=Nélaton Method.=—A lateral flap of skin is taken from the cheeks, beginning on a line with the root of the nose and as low as a point two thirds of its normal length. These flaps are made wide enough, so that when dissected up and folded inward they will meet on the median line, as shown in Fig. 382, having their raw surface facing outward. They are sutured along the median line. The frontal flap was cut in the form of a horse-shoe having its pedicle at the root of the nose just above the eyebrows, and being about three centimeters wide and six long. The skin at the outer margins was dissected up from the bone, leaving sufficient attachment at its center to allow for a bony plate. With a fine saw, and in the manner shown in Fig. 383, this plate was made from the frontal bone, being about two and a half centimeters wide and four long. [Illustration: FIG. 382.—First step. FIG. 383.—Making bony support to flap. NÉLATON METHOD.] There is some difficulty associated with the making of the flap, which ends at the superior border of the frontal, leaving the pedicle composed only of skin. The flap is now turned down, exposing its raw surface. The bony plate is sawed through at the median line, as shown in Fig. 384, and the skin of the flap is also divided along this line, giving two partly bone-lined flaps. The two flaps are now rotated downward before the lost nose, so that their raw surfaces face inward, and in this position they are sutured along the median line and the sides, as shown in Fig. 385. The method gives an angular dorsum of satisfactory consistency to the new nose, but furnishes a serious drawback, in that the cicatrization along the median line is liable to affect the shape of the organ and leaves a prominent scar line. The use of two small pedicles is another objection in that the danger of gangrene is greater as the nourishment to each flap is less. [Illustration: FIG. 384.—Cutting through bony plate. FIG. 385.—Disposition of frontal flap. NÉLATON METHOD.] =Israel Method.=—From the ulnar side of the left forearm Israel cuts a skin flap, as shown in Fig. 386, with its smaller end nearest to the wrist, where it is detached, the pedicle being broad, assuring of better nourishment to the flap. The narrow end of the flap is cut down to the bone, then the sides are dissected up until the borders of the ulna are reached on both sides, reserving an adherent strip about eight millimeters wide and six centimeters long. [Illustration: FIG. 386.—ISRAEL METHOD.] The bone below this strip is now removed with the saw from the lower end upward, and ending about one centimeter beyond the base line of the flap, where the strip so made is left connected to the bone proper. The flap is now raised gently and bent upward without breaking the bone. It is sawed half through, transversely, at a point corresponding to the lobule of the nose.