It is sutured rim down to the freshened wound in the wing. The secondary deformity of the ear is brought together by suture. The author has found that this cannot be readily done without puckering the rim when the line of excision is made convexly, and advises making it triangular instead. The defect of the nose should be freshened to the same form. The flap from the ear now becomes ideal, fits better, is more readily sutured in place. No sutures should, however, be made through the apex of this triangular flap to avoid gangrene at this frail point. Silk isinglass at this point acts as a splint. Dry aristol dressings are used. [Illustration: FIG. 453.—KÖNIG METHOD.] =Kolle Method.=—When the defect of the ala is elongated and involves only part of the rim, the author has taken a cutaneo-cartilaginous flap from the back of the ear. The flap is cut vertically, and is made to include a strip of cartilage of about the size and form of the defect. The flap is immediately sutured to the freshened defect and folded upon itself with the cartilage facing the inferior margin of the defect. The flap thus employed exhibits an epidermal face, both inside and outside as well as at the rim of the wing. A case in which this method was used is shown in the illustrations 454 and 455, in which the defect is shown in the former figure, and the result after the sutures were withdrawn on the sixth day in the latter. The secondary wound is easily brought together by suture, as the skin is quite flexible at this point. [Illustration: FIG. 454. FIG. 455. AUTHOR’S CASE.] RESTORATION OF NASAL LOBULE This defect of the nose has been restored by the use of skin flaps taken from the forehead, the nose itself, or from half or the whole thickness of the upper lip. The author does not advocate the use of such flaps except those taken from the skin of the inner side of the forearm, just below the wrist, made according to the Italian plan, as heretofore described. The pedicle of such a flap is cut about the twelfth day, and at a later period, when the inferior or free margin has cicatrized, the subseptum is formed and sutured to the remaining stump or into a wound in the upper lip made to receive it. The skin of the forearm is nearer to the thickness of the skin of the nose; hence a flap from it is preferable to that taken from the arm. The method of obtaining the flap has been fully described heretofore. The results obtained are excellent in most cases. The resulting cicatrix is barely visible, and may be later improved by scar-reducing methods, later described under that heading. The appearance of the flap after the pedicle has been severed and the subseptal section has been put into place may be observed in Fig. 456, and the final appearance after total contraction, in Fig. 457. [Illustration: FIG. 456.—Flap detached. FIG. 457.—Final appearance. AUTHOR’S CASE.]