=Nélaton Method.=—The method involved a preparatory and a final operation. The preparatory operation has to do with obtaining and placing in position the section of cartilage under the skin flap wherever located. The final operation may or may not consist of two sittings, the first being necessitated by the bringing upon the remains of the nose a flap of skin to line the one brought down in front of it and containing the support. _Preparatory Operation._—To begin properly, the frontal flap to be utilized is marked out on the forehead with nitrate of silver the day before the operation, so that its outline will be plainly discernible, and act as a guide for the placing of the cartilage. The shape of the flap is fashioned as shown in Fig. 388. [Illustration: FIG. 388.—NÉLATON METHOD. Outlining of frontal flap.] In the illustration is also shown the incisions later made to utilize the borders of the remaining nose to line the frontal flap. This is done by making an inverted V incision at a distance from the inner borders, corresponding to the lateral line of union of the frontal flap with the face. The resultant flap is turned down, raw surface outward, curtainlike, and is sutured to the frontal flap, where it falls into position. The flap outline shows that its pedicle lies between the outer end of the inner third and above the right eyebrow and a little to the left of the median line at the root of the old nose. This will avoid considerable tension at this point, the rotation as made being ninety degrees. Nearly horizontally, as shown in the figure, a line is drawn through the center of the flap, showing the position the strip of cartilage is to occupy. This done, a pattern of the outline is cut from stiff paper or oiled silk to preserve as a guide for the making of the flap, it being understood that the outlining has been made to the measurement of the required nose, allowance being given for cicatricial contraction. This done, the surgeon having prepared the skin about the costal prominences of the left thorax, he proceeds as follows: A vertical line is drawn the width of two fingers to the right of the nipple, as shown in Fig. 389, the length of the line being obvious. [Illustration: FIG. 389.—METHOD OF LOCATING STRIP OF CARTILAGE.] Where the vertical crosses the eighth costal cartilage an incision is made downward over and not under the border of the cartilage. The incision extends downward for a distance of eight centimeters, where it is turned upward at an angle, as shown, to a distance of three centimeters. By separating the muscular aponeurosis made visible by this incision the lower edge of the eighth costal cartilage is exposed. The knife is moved along the lower edge of the cartilage, dividing the fibers of the insertion of the transverse muscle from without inward. The cartilage can now be grasped between the thumb and forefinger and be forced out of its normal position after a slight anterior dissection.