Rhinoplastic Operations.

Rhinoplastic Operations. When a portion or the whole of the nose has been destroyed by accident or disease, the deficiency may be restored by a transplantation of skin from an adjoining healthy part. When the whole nose has to be replaced, the following course is usually adopted. A triangular piece of leather or gutta-percha is cut into the shape of the nose, and is extended on the forehead with its base uppermost; its boundaries, when thus flattened, are marked out on the skin with ink. Any remains of the old nose are then pared away, and a deep groove is cut round the margins of the nasal apertures. When the bleeding from these incisions has stopped, the marked portion of the skin of the forehead must be carefully dissected away, till it hangs by a narrow strip between the eyebrows. When the bleeding from the forehead ceases, the flap must be twisted on itself, so that the surface which was originally external may remain external in the new position, and its edges must be fastened with stitches into the grooves prepared for their reception. The nose thus made is to be supported with oiled lint, and well wrapped in flannel to keep up the temperature. When complete adhesion has taken place, the twisted strip of skin may be cut through, or a little slip may be cut out of it, so that the surface may be uniformly smooth. Either at the first operation or subsequently a new columna (the front part of the septum) is usually formed from the skin of the upper lip. When only a part of the nose, as one side only, or the septum, requires to be restored, modifications of the above operation are required, and the skin, instead of being taken from the forehead, is taken from the cheek or the upper lip. This operation is called the Indian Method, having been introduced from the East and first successfully performed in Europe by Carpie in 1814. It has almost entirely superseded the Taliacotian Operation, first performed by Tagliacozzi or Taliacotius (1546-99), professor of Anatomy and Surgery at Bologna, and described in his famous work De Curtorum Chirurgia per Insitionem (1597). He took the skin for the new nose from the arm of his patient; and there is no reason why the operation which he describes, although inferior in many respects to that at present adopted, should not be successful. The difficulty and irksomeness of keeping the arm sufficiently long in apposition with the face (a period of about twenty days) is the chief objection to his method. For further details, see Holme's System of Surgery, or Erichsen's, or any other surgical manual.