Through the sacrifice of two triangles a large oblong or square defect may be covered, the excisions being shown in Fig. 69 and the suturing in Fig. 70. [Illustration: FIG. 69. RECTANGULAR-BITRIANGULAR EXCISION.] [Illustration: FIG. 70. COAPTATION OF WOUND.] III. TWISTING METHOD Although in several of the above methods the flaps are rotated and slightly twisted, the following are only classified with those under this division. Where an elliptical defect is to be obliterated the curved incision shown in Fig. 71 can be satisfactorily employed, leaving but a small area to granulate over. The suturing is depicted in Fig. 72. [Illustration: FIG. 71. WEBER METHOD.] [Illustration: FIG. 72. COAPTATION OF FLAPS.] In this the twisting of the flaps is but little, while in the following, in which the defect is of similar shape, the twisting is more apparent; so much so, that a fold at the root of the flap may be induced to some extent. The excision and incisions are shown in Fig. 73, and the method of bringing the parts together in Fig. 74, leaving a small area for granulation. [Illustration: FIG. 73. ELLIPTICAL EXCISION.] [Illustration: FIG. 74. COAPTATION OF FLAPS.] Considerable twisting of flaps is shown in covering triangular parts in Figs. 75 and 76. [Illustration: FIG. 75. TRIANGULAR EXCISION.] [Illustration: FIG. 76. COAPTATION OF FLAPS.] In this only a small surface is left to granulate over, while in the following the parts are entirely covered. The excision and incisions are shown in Fig. 77, and the method of approximation and suturing in Fig. 78. [Illustration: FIG. 77. TRIANGULAR EXCISION.] [Illustration: FIG. 78. COAPTATION OF FLAPS.] In covering a square area considerable twisting must be resorted to, as shown in Figs. 79 and 80, leaving a portion to granulate. [Illustration: FIG. 79. LENTENNER METHOD.] [Illustration: FIG. 80. COAPTATION OF FLAP.] Where the area is irregular and formed somewhat as in Fig. 81, bilateral incisions are made and the flaps twisted into place and sewn, as in Fig. 82. [Illustration: FIG. 81. BURNS METHOD.] [Illustration: FIG. 82. COAPTATION OF FLAPS.] IV. IMPLANTATION OF PEDUNCULATED FLAPS BY BRIDGING In this method the flap to be utilized in covering a defect is taken from a distant part of the body, as, for instance, from the arm. The flap thus taken at first remains attached at its distal end to the tissue of the arm by a pedicle, which is not severed until a circulation has been established between the flap and the part of the human economy to which its free end has been attached by suture, the arm being held in position in the meantime by a suitable contrivance, as shown in Fig. 83. [Illustration: FIG. 83.—TAGLIACOZZA HARNESS.] These pedunculated flaps, bridging over space, may likewise be taken from the forearm, the hand, or the thoracic region.