For very small losses of tissue about the lobule nonpedunculated skin grafts are to be employed. The author advises including some of the areolar tissue with them to avoid contraction. These are to be dressed with the blood method referred to under skin grafting. Perforated rubber tissue is to be used next to the epidermal surface to prevent the dressings from tearing away the graft when changed. Fine twisted silk is most suitable for suturing purposes. The loops must not be drawn too tightly and the knot be made so that it rests upon the healthy skin of the nose. RESTORATION OF SUBSEPTUM For the correction of this defect various methods are given, and all of these must be modified more or less, to meet the requirements or extent of lost tissue. In some cases the entire subseptum is absent, while in others there is more or less of a stump remaining. Again in some, the subseptum required is unusually wide and in others quite narrow. While a number of surgeons prefer making the flap to restore it from part or the whole thickness of the upper lip, as will be shown, the author believes the best results are to be obtained with the Italian flap method, if there be great loss of tissue, or to attempt to restore smaller defects with cartilage-supported nonpedunculated flaps taken from back of the ear, as heretofore described, or the cartilage to be used as a support may be taken from the nasal septum itself, having its pedicle posteriorly. This strip of cartilage is brought downward, freed at either side from its mucosal attachment, and the skin flap to be used is then made wide enough to be sutured to the inferior mucosa margins as well as to the skin of the lobule. The method of taking a sliding flap from the healthy skin of the nose is not advisable, because of the resultant disfigurement. The tissue of the lip, on the other hand, can be used, since the secondary wound can be readily drawn together, leaving only a linear scar. In men, this may be hidden by the mustache. When the Italian method is used, the method referred to in restoration of the lobule is to be followed. =Blandin Method.=—The flap is taken vertically from the entire thickness of the upper lip, as shown in Fig. 458, having its pedicle at the base of the nose. This strip of tissue is turned upward, mucosa outward, and its freshened free end is sutured to the raw surface of the lobule. The secondary wound of the lip is sutured as in ordinary harelip, as shown in Fig. 459. The mucosa soon takes on the appearance of skin, but in most cases remains pink in color. The flap taken in this way should not be made too wide. [Illustration: FIG. 458. FIG. 459. BLANDIN METHOD.] =Dupuytren Method.=—The flap is taken vertically from the skin of the upper lip, reaching down at its free end to the vermilion border, as shown in Fig. 460.