Wounds about the meatus are liable to result in stenosis, which should be guarded against by packing of small strips of gauze or in the case of loss of substance immediately about the orifice by the employment of a sliding flap taken from the skin of the vicinity or by the transplantation of a nonpedunculated skin flap taken from some other part of the body and sewn into place. RESTORATION OF THE AURICLE If a loss of substance of the auricle cannot be avoided, the surgeon must rely upon otoplastic means to make up the deficiency. For the best cosmetic defects it is desirable to have as much of the cartilage remaining as possible. The stump of the ear is freshened at its outer margin with the bistoury and the frontal skin carefully dissected away from the cartilage to the extent of a quarter inch. A flap, one third larger than the defect to be supplied, is now outlined on the skin back of the ear in such a way that the flap included therein will not be subjected to too much torsion. This flap must necessarily vary in shape and size, according to the nature of the deformity to be corrected. It may even extend into the hair of the scalp over the squamoparietal region of the head or a part of the neck laterally and below the ear. This flap, after careful estimation as to size, should be dissected up freely down to the periosteum, leaving a bridge of tissue at the point where the least resistance will be caused after its free end has been sutured to the remains of the ear. The free flap is stitched to the stump with several silk sutures. After bleeding has been controlled, a few layers of borated gauze are introduced under the flap to prevent its reattachment and to encourage its thickening, and the entire site of the operation dusted over with an antiseptic powder, and covered with loose folds of sterile gauze. A bandage can be lightly applied over the whole to keep the parts in place. The success of union of the flap depends upon the immobility of the parts while healing is taking place. The patient is to rest at night in a semirecumbent position with the head held down firmly on the uninjured side with the aid of a tight-fitting linen cap made for the purpose and tied by attached tails of the same material to the bed in such a way that the head cannot be turned during sleep, yet allowing of more or less movement in either direction, never enough, however, to cause tension in the flap. During the day the patient should be on his feet as usual, since the operation is hardly severe enough to compel absolute rest. As soon as the union of the flap to the ear has been established, which is about the eighth day, the sutures are carefully removed to avoid irritation, but the pedicle of the flap is not to be severed until the tenth or fifteenth day, when satisfactory circulation has been established. The flap when severed will shrink more or less, but will be seen to be somewhat thicker than when dissected up in the primary operation.