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2 is said to have restored a lost nose by using a flap from the arm. The first report of the employment of the arm flap in medical literature is a brief note found in a work on anatomy by Alexander Benedictus, published in Venice in 1497. Other surgeons of more or less repute were impressed with this work, and various allusions to the operation are to be found in surgical works of the sixteenth century.

The work of Caspar Tagliacozzi (1546-1599) published in 1597, was the first systematic treatise on plastic surgery and was entitled "De Curtorum Chirurgia per Insitionem," a volume of 298 pages including 22 full-page plates. In it he described several operations, but gives special prominence to his method of rhinoplasty, in which he used a pedunculated flap from the arm.

Two parallel incisions about 20.cm. long (8 inches) and 10.cm. apart (4 inches) were made down to the fascia on the anterior aspect of the left arm. The flap was separated from the fascia, and was kept away from its bed with oiled linen, but the pedicles at each end were not divided. After a fortnight when granulation and thickening had occurred, the upper pedicle was cut and the flap was sutured into the defect, after the edges had been revivified. The arm was held in position by a special harness, and after three weeks the other pedicle was amputated from the arm, and the flap was shaped and fitted into the desired position. This is called the Tagliacotian or Italian Method.

The pupils of Tagliacozzi continued to carry out his method, but within a few years it was lost sight of, and in course of time began to be considered impossible.

Reneaulme de la Garanne (1712) tried to rehabilitate the method, and proposed sewing into the defect the fresh flap, immediately after raising it without waiting for it to granulate. Despite his work, however, the art remained lost to practical surgery until 1816, when v. Graefe again revived Tagliacozzi's method, and reported one successful case. He modified the procedure by cutting the upper pedicle at once and by sewing the fresh flap into its place without waiting for it to granulate; thus making of it a single operation.

The Indian method was brought to the attention of European surgeons by a letter which was printed in the Gentleman's Magazine for October, 1794, p. 891, a part of which is as follows: "Cowasjee, a Mahratta of the caste of husbandmen, was a bullock driver with the English army in the war of 1792, and was made a prisoner by Tippoo, who cut off his nose and one of his hands. In this state he joined the Bombay army near Seringapatam, and is now a pensioner of the Honourable East India Company.