The secondary wound lying between the lines _E_ and _E’_, occasioned by the sliding downward and leaving the triangular defect _F_, is allowed to heal by granulation. The lateral flap is fixed along the line _A_. Usually the pedicle of flap _C_ need not be cut, as it adjusts itself under primary union. The secondary lip wound is closed at once by suture. The author has also used the inverted V incision of Dieffenbach, including the cartilage or part thereof that remains above the defect, and has moved this flap downward, suturing in Y fashion with good results. [Illustration: FIG. 447. FIG. 448. AUTHOR’S METHOD.] =Denonvillier Method.=—The operation is similar to that of Dieffenbach and the author’s modification just mentioned. Its advantage, as in the latter, is that the inferior border or nasal rim remains intact, and contains what cartilage remains above the defect. The shape of the incision is as shown in Fig. 449. The flap _A_, _B_, _C_ includes the skin and such cartilage as can be used, while the rim below the line _B_, _D_ retains its lower cicatricial border. The flap is slid down until the defect has been overcome, and the resultant superior triangular wound is allowed to heal by granulation. The dissection of the flap is made down to the line including the skin or cartilage referred to. At the dotted line _B_, _D_ the whole thickness of the tissue except the overlying skin is involved. [Illustration: FIG. 449.—DENONVILLIER METHOD.] =Von Hacker Method.=—The flap _A_, _F_, _C_, as shown in Fig. 450, is cut from the entire thickness of the side of the nose attached by its posterior pedicle _C_. This flap is moved downward, and its anterior border is sutured along the freshened line _A_, _B_, as in Fig. 451, leaving a triangular defect, _A_, _F_, _C_. Two little triangular flaps of skin are dissected up, skin only, at _D_, _E_, _C_ and _H_, _G_, _C_. Next a rectangular flap, _I_, _K_, _L_, _M_, is dissected up from the cheek, as in Fig. 452, including some areolar tissue. The flap should be made sufficiently long, so that when folded over it will fit into the defect without tension, at the same time allowing for contraction. This flap is sutured into the defect made by the making of the first flap, as shown. The secondary wound of the cheek is brought together by suture, except for a small triangle near the pedicle to avoid its constriction. Its raw surface is allowed to heal by granulation. The pedicle is severed in about fifteen days, and may be cut in triangular fashion to make it fit smoothly into the slight defect in the skin just posterior to it. [Illustration: FIG. 450. FIG. 451. FIG. 452. VON HACKER METHOD.] =König Method.=—In this novel method a flap somewhat of the form of the defect is taken from about the entire thickness of the rim of the ear, as shown in Fig. 453. This flap should be made slightly larger than the defect, since it contracts somewhat immediately after excision.