Nothing should be done for a few days hereafter except to keep the granulating surfaces of the flap and back of the ear aseptically clean and healthy. As soon as the flap loses its pale color and takes on a pinkish glow it may be deemed safe to cover the granulating or secondary wound on the head with grafts of skin, using whatever method most suitable for the purpose. The transplantation of a single flap of skin taken from the anterior border of the arm is perhaps productive of the best result. To assure of success the graft may be healed under the blood dressing; the methods for which have been fully described heretofore. Once the secondary wound is healed the surgeon’s attention must be given to the flap attached to the stump. By the aid of the judicious use of the nitrate-of-silver pencil certain parts of this flap may be stimulated to become thickened. The upper or outer border of the flap should be taken under operation first to form the new helix of the ear. This can be done by making several incisions along its free edge and gently turning backward these small flaps so that their raw surfaces face that of the flap. This procedure, if neatly done, will eventually give a thickened border to the superior rim. Should the flap have been cut large enough to permit of lining its entire back this can be done, but care must be exercised not to cause a too abrupt folding over of the same, as gangrene is likely to result. The more slowly this freshening is accomplished the better will the result be eventually. If, however, this flap will not permit of autolining, and its raw surface presents a healthy granulated appearance, recourse may be had to the transplantation of a flap from the arm upon it and fastened to the denuded edges of the aural flap. As soon as healing has been established a number of delicate, often complicated incisions are made in the newly formed part of the ear to give it proper shape and size. Kuhnt has obtained excellent results in a case where he employed a flap from the back of the ear, combined with two pedunculated tongue-shaped flaps taken from the cheek above and the neck below, which he twisted about back of the flap of the newly formed ear, so that their epidermal surfaces faced its raw surface with the object of giving greater thickness to the ear at that point. At best, however, the restoration of an entire ear may be considered impracticable, and only in such cases where the greater part of the ear remains can cosmetic results be looked for. In the illustration shown the author restored the upper third of the ear shown above the line drawn obliquely across the ear. Seventeen delicate operations were necessary to obtain the result (see Fig. 115). [Illustration: FIG. 115.—PARTIAL RESTORATION OF THE AURICLE. (Author’s case.)]