The union between cartilage and bone is exposed. The chisel is used to divide the cartilage about one centimeter from the rib, after the costal or inner extremity has been made. The position of the hands and the exposed cartilage is shown in Fig. 390. [Illustration: FIG. 390.—EXCISING STRIP OF COSTAL CARTILAGE.] This accomplished, the wound is temporarily dressed. The cartilage is then fashioned to suit the required size and shape. It is thinned down on its lower surface to about three millimeters in diameter. This thickness is maintained to a length of two and a half centimeters, the part being intended for the subseptum. A notch is made on the upper surface at this distance from the end, which marks the point at which it must be eventually bent to form the point of the nose. This notch is cut to two thirds of the entire thickness. The required length, that of the nasal line and its added septal length, is preserved. The cartilage being prepared is now ready for the insertion under the frontal periosteum at the site already marked. For this purpose a vertical incision one and a half centimeters, extending down to the bone, is made, as shown in Fig. 391. [Illustration: FIG. 391.—CARTILAGE PLACED UNDER FRONTAL FLAP.] The periosteum is peeled away from the bone with the dull or rounded handle of a knife. The cartilage is now thrust into the tunnel thus made, the thinned-down, notched-off section facing forward and lying toward the vertical incision. The skin wound is sutured and a gentle compress is used to keep the cartilage in contact with the periosteum, which requires at least two months. A longer interval of time is advocated to give greater vitality to the cartilage. The wound of the thorax is simply sutured and dressed as any surgical wound. _Final Operation._—The part cut is prepared as in the Hindu method. A lining for the frontal is made of such tissue as remains, and its freshened borders are sutured where possible, as shown in the last figure. When this cannot be done, a flap may be taken from the arm, as already suggested, or a Krause nonpedunculated skin flap may be used, according to the methods given heretofore. The epidermis is made to face inward. If either of these methods is used, the frontal lap is not brought down until healthy granulation has been established. The frontal flap is made to include the periosteum, from which it is separated with a blunt instrument. The cartilaginous strip will be found to be attached to the periosteum. The freed flap is now brought before the nasal defect and fitted into place. The cartilaginous strip should occupy the anterior median line. The subseptal cartilage is bent inward and downward and the skin of the flap is sutured to it with catgut to form the subseptum, as shown in Fig. 392. [Illustration: FIG. 392.—BRINGING DOWN FRONTAL FLAP.]