Gauze dressings are inserted under the flap. Several days later the superior pedicle is severed and the flap is sutured to the freshened margin of the nose. An application of borated vaselin on gauze is used as the dressing. The arm is held in position by a proper apparatus, a plaster-of-Paris fixture being used by the author. Six days later the brachial plexus is divided to half its width, and totally divided three days thereafter. Fifteen days later the free border of the flap is divided into three sections, the median one being made narrowest. The outer small flaps thus made are sutured to the remaining wings of the nose. Five days later the septum is formed of the remaining unattached flap, which is sutured to the stump of the old septum. It is not folded upon itself, but allowed to heal by cicatrization. Eight days later minor operations are performed to reduce the exuberant portions of the side flaps. =Berger Method.=—This author makes a flap of the skin above the border of the nose, which he turns down, raw surface outward, upon which he immediately brings a flap from the arm. The object of the lining is to give stability to the base of the new nose as well as to prevent curling and contraction of the rims of the nostrils. =Bayer-Payr Method.=—Two flaps two and a half centimeters wide are cut from the nasolabial furrow, extending down to the lower border of the inferior maxillary bone, as shown in Fig. 412. The flaps are dissected up and brought forward and upward, their raw surfaces meeting in the median line, where they are sutured upon one another to the extent of three centimeters, as shown in Fig. 413. The nasolabial wounds are brought together by suture except for a small triangular space near each pedicle, which are allowed to heal by granulation. The superior borders of the flaps were then united by suture to the freshened margins of the nose, which have been prepared as shown in the illustration. The septal ends of the two flaps are likewise sutured to the stump of the old septum. The raw or outer surfaces of the flaps are to be covered with Thiersch grafts when ready for them, though this may not be necessary with small flaps. The pedicles of the flaps are not cut until the end of the fourth week, when the fresh ends may be sutured to freshened surfaces of the wings made to receive them. The disposition of the parts at this period is shown in Fig. 414. [Illustration: FIG. 412.—First step. FIG. 413.—Disposition of flaps. FIG. 414.—Ultimate placing of pedicles after division. BAYER-PAYR METHOD.] =Ch. Nélaton Method.=—This author in cases of extensive destruction of the point of the nose advocates the lining of an Italian flap with skin flaps made in similar manner, as in the foregoing operation.