La chirurgie plastique ; ses principes et pratiques . .-I et 2. L'avant et pro-file view avant utilisation. 3 et 4. Vue de profil avant et deux semaines après l'implanta-tion d'un greffon cartilagineux libre des côtes. Noter la position de la cicatrice et l'aspect improvementin. 5. Le résultat dix-neuf mois après l'opération. l'perichondrium est loin de la peau, ainsi qu'avec le cartilagecompletely dépouillé. Lorsque l'extrémité de la truffe n'a pas besoin d'appuyer sur le cartilageis, simplement placé dans le canal préparé pour elle. Le cartilage peut être 46i CHIRURGIE PLASTIQUE assez épais à gauche- le point de grande

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Plastic surgery; its principles and practice . .—i and 2. Front and pro-file view before operation. 3 and 4. Front and profile view two weeks after the implanta-tion of a free graft of cartilaginous rib. Note the position of the scar and the improvementin appearance. 5. The result nineteen months after operation. the perichondrium is away from the skin, as well as with the cartilagecompletely stripped. When the tip of the nose does not need depressing, the cartilageis simply placed in the channel prepared for it. The cartilage may 46i PLASTIC SURGERY be left quite thick at- the point of greatest depression, or it may bereinforced by shorter pieces secured beneath it. When we desire to depress the end of the nose, the tunnel havingbeen made to the tip, the cartilage is bent and is sprung into the channelprepared for it, impinging against the frontal bone and extending tothe tip of the nose. It is secured from lateral slipping with two orthree sutures of fine catgut, and the skin is closed with on-end mattresssutures of horsehair.. 1234 5 Fig. 500.—Saddle nose following lues. (Surg. No. 44327). i and 2. The remaining por-tion of the nose is retracted almost to the level with the cheeks. Note the scant amount ofskin, and also the length and prominence of the lip. The white spot in the center of thefloor of the nose is a misplaced normal tooth. 3, 4 and 5. The appearance of the nose afterthe implantation of a piece of cartilage to bring out the bridge, and also pieces to hold outthe alee. Infection occurred on the left side of the nose and a portion of the cartilagesupporting the ala on that side was lost. The septum was formed from flaps taken fromthe upper lip by the method shown in Pig. 529. A cast made of one of the flexible paraffin mixtures and replacedevery 24 hours during the first week, is an excellent dressing, andminimizes the scar. I have used free cartilage transplants in a number of instances, and find them most satisfactory. Sometimes the spring of the

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