A curved incision is made just below the tarsal border, freely loosening the attached conjunctiva in this manner. The cicatricial tissue or other cause of the defect is thoroughly excised and the lids fixed together by suture. The wound is then fully exposed. A curved incision, as shown in Fig. 97, is now made, with its base in line with the superior line of the raw surface. It is carefully dissected up and twisted into position and held by suture (Fig. 98). [Illustration: FIG. 97. FIG. 98. AMMON-VON LANGENBECK METHOD.] The sides of the wound made by the excision of the flap are brought together by an interrupted suture. The skin of the cheek is liable to contract more readily than that from the temporal region, because it is thicker. Again, it is less suitable for grafting because of its subcutaneous layer of adipose tissue. =Dieffenbach-Serre Method.=—Where the defect is too large to be covered with any of the preceding methods, as is often the case following the extirpation of carcinomata, a rhomboid flap can be utilized as shown in Fig. 99. The extirpation incision is made in the form of a V. The faulty tissue or scar is removed, care being exercised to retain as much of the conjunctiva as possible. A rhomboid flap is then taken from the lateral aspect of the cheek and slid over the defect and sutured into place, as shown in Fig. 100. [Illustration: FIG. 99. FIG. 100. DIEFFENBACH-SERRE METHOD.] The objection to this method is that the extensive contraction following the healing of the wound made by the raising of the flap causes the lid to be drawn outward. This wound is usually allowed to heal by granulation, but it is better to place Thiersch grafts over the area which cannot be closed by suture, either immediately or as soon as a good granulating surface has been obtained and the sutured portions have become healed. The outer or free margin of the conjunctiva is sutured to the upper free border of the rhomboid flap or enough of the flap should be at first provided by incision to warrant the turning in of its superior or palpebral border after it is slid into place. In such case, however, it is best to provide mucous-membrane grafts from the lip of the patient to overcome the loss of conjunctiva (Wolfer). Because of the splendid success obtained with temporal flaps it is better to follow the method of Fricke in the above operation, changing the shape of the flap to suit the form of the defect to be covered.