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 Intercultural
Experience and
Identity
1DUUDWLYHVRI&KLQHVH'RFWRUDO
6WXGHQWVLQWKH8.
LILY LEI YE

3DOJUDYH6WXGLHVRQ
&KLQHVH(GXFDWLRQLQD
*OREDO3HUVSHFWLYH
 Palgrave Studies on Chinese Education
in a Global Perspective

Series Editors
Fred Dervin
Department of Teacher Education
University of Helsinki
Helsinki, Finland

Xiangyun Du
Confucius Institute
Aalborg University
Aalborg, Denmark

“The burgeoning literature on Chinese international students is dominated

by writers and researchers from host institutions who inevitably present issues
through the prism of their own experience. Lily Ye, in contrast is one of a
small but growing generation of Chinese writers who have received their post-­
graduate education in the English-speaking world and are thus able to draw
both on the perspectives of fellow students and on their own lived experience.
Dr Ye’s use of Giddens’ project of the reflective self to interpret the narratives
of Chinese PhD students is original, exciting, challenging and illuminating.
Participants emerge not as passive victims of a system where they often face
multiple disadvantages, but as active agents who mould their international
experiences in ways which mirror their aspirations.”
—Professor Viv Edwards, University of Reading, UK
The transformation of China into a global super-power is often attrib-
uted to the country’s robust education system and this series seeks to
provide a comprehensive, in-depth understanding of the development
of Chinese education on a global scale. The books in this series will
analyze and problematize the revolutions, reforms, innovations and
transformations of Chinese education that are often misunderstood or
misrepresented beyond its own borders and will examine the changes in
Chinese education over the past 30 years and the issues as well as chal-
lenges that the future of Chinese education faces. For more information
or to submit a proposal please contact Eleanor Christie (eleanor.chris-
tie@palgrave.com)

More information about this series at

http://www.palgrave.com/gp/series/14568
 Lily Lei Ye

Intercultural
Experience and
Identity
Narratives of Chinese Doctoral
Students in the UK
Lily Lei Ye
Beijing Institute of Fashion Technology
Beijing, China

Palgrave Studies on Chinese Education in a Global Perspective

ISBN 978-3-319-91372-8 ISBN 978-3-319-91373-5 (eBook)
https://doi.org/10.1007/978-3-319-91373-5

Library of Congress Control Number: 2018940763

© The Editor(s) (if applicable) and The Author(s) 2018

This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse
of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by
similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt
from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with respect to the material contained herein
or for any errors or omissions that may have been made. The publisher remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

Printed on acid-free paper

This Palgrave Macmillan imprint is published by the registered company Springer International
Publishing AG part of Springer Nature
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
 Acknowledgements

I am indebted to everyone who has helped me and supported this book

project. In particular, I would like to thank all of my participants.
Without your help, this study is impossible to complete. My deepest
and heartfelt gratitude goes to Professor Viv Edwards for being such
a wonderful mentor and role model who provides me guidance and
advice, generosity and consistent support throughout this book project.
Without her support, this research could have never evolved into book
form. My sincere thanks go to Professor Fred Dervin and Professor
Xiangyun Du, the series editors, for their support of this project. My
thanks also go to Eleanor Christie and Rebecca Wyde at Palgrave
Macmillan for their expertise and professionalism that makes the pub-
lication process flow smoothly. A special thanks to my family for their
unconditional support, reminding me of what really matters. Words
cannot express how grateful I am.

v
 Contents

1 Setting the Scene for the Narratives to Follow 1

Background 2
Internationalisation of Higher Education 2
Studying Abroad 6
International Doctoral Students 12
The Importance of Researching on Chinese International
Doctoral Students 15
Significance of the Study 16
Overview of the Book 18
References 21

2 The Story of Researching Chinese International Doctoral

Students’ Identity 39
Research Participants 39
An Interpretive Epistemology 42
A Narrative Approach 43
Narrative Analysis and Thematic Analysis 49
Reflexivity 51
References 52

vii
viii   Contents

3 Engaging with the Existing Stories 57

Culture, Intercultural Adaptation and Intercultural
Competence 58
Understanding Culture 58
Understanding Intercultural Adaptation 59
Understanding Intercultural Competence 62
The Intercultural Experience of Chinese International
Students 67
The Intercultural Experience of Chinese International
Doctoral Students 71
Critical Voices on Cultural Essentialist View of Chinese
International Students 73
The Cultural Essentialist Approach to Understanding
Chinese International Students 73
Challenging the Cultural Essentialist View of Chinese
International Students 74
Beyond Essentialist Dichotomies 78
Concluding Remarks 80
References 80

4 Exploring the Self Through Giddens and Bourdieu 95

Preface 95
The Development of Modern Concept of Identity 98
Giddens’ Reflexive Project of the Self 102
The Reflexivity of Late Modernity 103
The Reflexive Project of the Self 104
Critical Voices on Giddens’ Theory of Self-Identity 108
Bourdieu’s Concepts of Habitus, Field and Capital 109
Field and Habitus 110
Capital 111
Critique of Bourdieu’s Concepts 113
Concluding Remarks 114
References 115
 Contents   ix

5 A Dialogue with the Past: Thinking Through Lifestyle

Choices 123
Introduction 123
Stories of Lifestyle Choices and Life Planning 124
Anyone Who Has the Courage to Do This Is Remarkable 125
I Felt That I Should Give My Career a Boost 128
Doing a Ph.D. Is a Kind of Investment 130
I Wanted to See What the World Was Like 131
This Experience Would Be Admired by Other People 133
The Education System in Western Countries Is Better 135
I Wanted to Challenge Myself 136
I Wanted to Change My Career Path 137
Constraints and Dilemmas 138
Concluding Remarks 143
References 143

6 Surviving and Thriving in the New Field: Keeping the

Narrative Going 147
Introduction 147
Maintaining a Sense of Ontological Security 148
I Feel Myself a Bit Like a “Ghost” 148
Fish in Water 150
It Is Because of Who You Are 151
I Always Reminded Myself That Two Educational Systems
Are Different 154
It Is Normal for This to Happen 155
Being Confident 157
Self-Reflexivity as a Resource 159
Creativity 162
The Perceived Language Problem 162
Perceived Discrimination 165
Ontological Identity 166
Autonomy 169
Coping with Language Challenges 170
Coping with Doctoral Study 171
Supervisor’s Help 176
x   Contents

Authenticity 177
Concluding Remarks 180
References 181

7 Growing and Becoming: The Expanded Self 187

Introduction 187
Stories of Personal Growth and Transformation 188
Cultural Awareness and Heightened Reflexivity 188
Independence 194
Authenticity 196
Perceived Self-Expansion and Transformation 197
Concluding Remarks 203
References 204

8 Bringing the Future into the Present: Thinking Through

Imagined Future Trajectories 209
Introduction 209
Imagined Future Trajectories 210
The “haigui ” Identity Is Double-Edged 210
I Will Run a Charity to Help Children with Serious
Illnesses 212
I Will Continue My Research Work 213
I Have Been Worried… 214
I Hope That I Can Set Up My Own Business 216
It Is Unlikely That I Will Continue to Teach High School
ESL in China 219
I Am Not Sure About Future 220
Concluding Remarks 221
References 222

9 Learning from the Narratives 223

Introduction 223
Summary of the Students’ Narratives 224
The Study 224
Self-Identity and Motivation for Study Abroad 225
Surviving and Thriving in the New Field 226
 Contents   xi

Self-Expansion and Personal Development 227

Summary 228
Contribution and Implications 228
Contribution to the Body of Knowledge 229
Implications for Theory 231
Implications for Practices 232
Study Limitations and Future Directions 234
Concluding Remarks 235
References 237

Bibliography 239

Index 279
 1
Setting the Scene for the Narratives
to Follow

This book explores a topic which has received very little attention to
date, namely the identity formation and negotiation of Chinese doc-
toral students in relation to studying abroad. The study offers a novel
way of addressing this research agenda by applying Giddens’ (1991)
theoretical framework on self-identity and Bourdieu’s (1977) concepts
of habitus, capital and field, privileging students’ agency and reflexivity.
The study draws on the narratives told by 11 Chinese doctoral students
at two British universities, which is balanced with extensive theoretical
reflections and critically reflexive analysis of situational and sociocul-
tural contexts. Significantly, this book moves away from the focus on
student adaption to an exploration of agency and identity, challenging
the culturalist and essentialised view of Chinese students as a homoge-
neous and sometimes problematic group, and pointing to implications
for theory and practice.
The book project is driven by my own intercultural experience of
studying, living and working in the UK, and originated from my per-
sonal interests in the field of culture, communication, language and
identity. In building a picture of the ways in which students’ self-­
identity is shaped by and shapes their experience of study abroad, the

© The Author(s) 2018 1

L. L. Ye, Intercultural Experience and Identity, Palgrave Studies on Chinese
Education in a Global Perspective, https://doi.org/10.1007/978-3-319-91373-5_1
2   L. L. Ye

narratives illustrate individual agency, motivation, self-determination

and reflexivity. Hopefully the findings of this study will inform the
future development of the internationalisation of higher education.
Furthermore, this book adds to the limited body of research in intercul-
tural education coming from a sociological perspective and opens possi-
bilities for theoretical triangulation.
In this chapter, I begin by providing the background information
against which this book project is conducted. I look at what is meant
by globalisation and internationalisation of higher education. I then
examine the phenomenon of studying abroad, which is followed by a
review of literature on international doctoral students. I point out the
importance of researching on Chinese doctoral students, which forms
a key part of the contextualisation of the current study. I also outline
the specific research questions that guide the study, and then explain the
significance of the book project.

Background
In this section, I situate the book project in the broad context of
globalisation and internationalisation of higher education. I then give
further background information, including current literature on study-
ing abroad and international doctoral students as well as the significance
of researching Chinese international doctoral students.

Internationalisation of Higher Education

Higher education in the era of globalisation has become more inter-

national and internationalisation continues to be an important issue
on the agenda of higher education (e.g. Egron-Polak and Hudson
2014; Maringe and Foskett 2010; Spencer-Oatey and Dauber 2017).
A great deal of literature focusing on globalisation and interna-
tionalisation of higher education has emerged over the years (e.g.
de Wit et al. 2015; Deardorff 2012; Egron-Polak and Hudson 2014;
Killick 2013, 2015; Knight 2015; Leask 2015; Marginson and Sawir
 1 Setting the Scene for the Narratives to Follow    
3

2005; Maringe and Foskett 2010; Taylor 2010). There are several
dynamically linked themes of internationalisation of higher education
in the current literature, which include student and staff mobility, rec-
ognition across borders of study achievements, transfer of knowledge
across borders, intercultural competence, internationalisation at home,
similarity or heterogeneity of national systems of higher education,
national and institutional policies on the international dimension of
higher education or internationalisation strategies, funding interna-
tionalisation and quality review of internationality (Kehm and Teichler
2007; Teichler 2009, 2010, 2017).
The terms globalisation and internationalisation are sometimes inter-
changeable, but they are different concepts. Globalisation is “the cata-
lyst” while internationalisation is the response in a proactive way (e.g.
Knight 1999). In other words, internationalisation can be understood
as the strategic response of higher education institutions to the driv-
ing forces of globalisation, which includes a variety of policies and
programmes covering three primary functions of Higher Education
Institution, namely, teaching, research and service to society (Altbach
et al. 2009; Marginson and Sawir 2005).
Globalisation is “the economic, political, and societal forces push-
ing 21st century higher education toward greater international involve-
ment” (Altbach and Knight 2007: 290), which is “the intensification
of worldwide social relations which link distant localities in such a
way that local happenings are shaped by events occurring many miles
away and vice versa” (Giddens 1990: 64). On the other hand, inter-
nationalisation is the process of integrating an international, intercul-
tural or global dimension into teaching, research and service functions
of higher education (Knight 2015; Maringe and Foskett 2010), which
“is a commitment, confirmed through action, to infuse international
and comparative perspectives through the teaching, research and ser-
vice missions of higher education” (Hudzik 2011: 6). de Wit (2002)
identifies four different institutional approaches of internationalisa-
tion: activity, rationale, competency and process. The activity approach
defines internationalisation in terms of categories or types of activity,
such as student and scholar exchanges. The rationale approach explains
internationalisation in terms of its purposes or intended outcomes.
4   L. L. Ye

The competency approach focuses on students and staff’s knowledge

and skills development. The process approach regards internationalisa-
tion as a dynamic and evolving process of integrating an international
dimension into the major functions of the institution.
The internationalisation of higher education is a changing and evolv-
ing process of integration, continuously influenced by globalisation, and
shaped by the international context in which it occurs (Knight 2004;
Smeby and Trondal 2005). The process of internationalisation of higher
education consists of two key components: abroad and at home (e.g.
de Wit et al. 2015). International abroad refers to any border crossing
activities such as study abroad, education abroad, students and staff
mobility; international at home concerns curriculum development and
activities that nurture international and intercultural understanding
and competences (Knight 2008). The concept of Internationalisation
at Home (IaH) can be veiwed as “any internationally related activity
with the exception of outbound student mobility” (Nilsson 2003: 31),
focusing on both international learning and intercultural competence
(Wachter 2003).
Higher education institutions adopt various internationalisation
strategies to cope with the changing cultural, economic, educational,
political and social environment caused by globalisation (Rienties and
Nolan 2014; Spencer-Oatey and Dauber 2017). These approaches
include: student and staff mobility (Bhandari and Chow 2008; Maddux
and Galinsky 2009; OECD 2012; see also Cantu 2013); international-
ising the faculty (Childress 2009; Green and Olson 2003); international
students’ recruitment (Cantu 2013; Knight 2004); internationalisation
of curricula and quality assurance (OECD 2012); internationalisation
through dual and joint programmes; and launching offshore campus
(OECD 2012).
Internationalisation of higher education can generate both bene-
fits and risks for higher education institutions in terms of administra-
tion, curriculum, pedagogy and learning outcomes (e.g. Stone 2006;
Kerklaan et al. 2008; Knight 2010). International students and staff
mobility, together with improved quality of education, are identified
among the most important benefits (Knight 2007). More recently,
Jibeen and Khan (2015) identify that the benefits brought about by
 1 Setting the Scene for the Narratives to Follow    
5

internationalisation of higher education include building, growing

and sustaining academic, social and economic capacity in developing
countries and brain gain for developed countries. Moreover, interna-
tionalisation enables higher education institutions to equip the skills
and qualities that students need for living and working in a globalising
world (HEA 2016; Spencer-Oatey and Dauber 2017), such as empa-
thy and intercultural maturity (King et al. 2005). Furthermore, interna-
tionalisation makes financial contribution to both the higher education
institutions and the economics of host countries. For instance, a recent
research conducted for Universities UK by Oxford Economics high-
lights the fact that international students in the UK generate invalua-
ble economic, societal and cultural benefits, and jobs in communities in
every region of the UK. This study finds that international students and
their visitors made significant contribution to the UK economy, which
includes about £25.8 billion on and off-campus spending for 2014–
2015. The spending by international students also supported 206,600
jobs all over the UK (Universities UK, 2017).
Though the process of internationalisation holds many benefits, it
brings challenges, controversies and risks to the development of higher
education (Jibeen and Khan 2015; Knight 2007). For instance, Knight
(2007) points out that commercialisation and commodification of edu-
cation programmes, low-quality providers and brain drain are the top
three risks of internationalisation. In addition, critical voices on the
income and profit-seeking motives of internationalisation have been
raised (e.g. Stein 2016). In the literature review, Jibeen and Khan
(2015) identify that the loss of cultural or national identity, homoge-
nisation of international curriculum and quality assurance are potential
problems associated with the process of internationalisation.
As mentioned earlier, internationalisation of higher education can
take different forms, ranging from international students and staff
mobility, partnerships and collaboration in research and teaching, the
internationalisation of curricula, international or comparative education
programmes and offshore campuses (Anderson 2005; Naidoo 2006;
Olson et al. 2006; Sawir 2013; Wamboye et al. 2015). Among these
options, international students and staff mobility are particularly impor-
tant to the process of internationalisation of higher education (e.g. Scott
6   L. L. Ye

2006; Teichler 2017). It is not surprising that much of the research

undertaken on internationalisation of higher education has focused on
studying abroad.

Studying Abroad

Every year a large number of students choose to study abroad and this
number is growing steadily. Studying abroad has become a global trend
(e.g. Andrade 2006; Alghamdi and Otte 2016) and an essential part
of internationalisation, which is believed to offer opportunities for stu-
dents to build global competence and become “global citizens” (e.g.
Hser 2005; Spencer-Oatey and Dauber 2017). In the past two decades,
English-speaking countries, such as Australia, Canada, New Zealand,
the USA and the UK, have been receiving increasing number of inter-
national students mainly from Asian countries, particularly mainland
China (Marginson and McBurnie 2004). The UK is currently the sec-
ond most popular destination for international students after the USA
and attracts a substantial number of overseas students each year. For
instance, in 2014–2015, there were 437,000 international students
studying in the UK (EU and non-EU), accounting for 19% of all stu-
dents registered at UK universities (Universities UK, 2017). Due to the
important roles played by international students, the phenomenon of
studying abroad has received attention in fields such as intercultural
communication (e.g. Byram and Feng 2006; Jackson 2010; Murphy-
Lejeune 2002; Messelink et al. 2015; Zhou 2014), international edu-
cation (e.g. Andrade 2006; Durkin 2011; Gu et al. 2010; Jackson
et al. 2013; Kim 2011, 2012; Marginson et al. 2010; McClure 2005;
McDonald 2014; Menzies and Baron 2014; Robinson-Pant 2009;
Yoon and Portman 2004), psychology (e.g. Ward et al. 2004) and soci-
ology (e.g. Goode 2007). Previous research has explored various aspects
of the lived experience of international students, including counsel-
ling international students (Kambouropoulos 2015; Yi et al. 2003);
developing social support systems for international students (Paltridge
et al. 2012); international students’ language proficiency develop-
ment (MacIntyre et al. 1998; MacIntyre 2007); international students’
 1 Setting the Scene for the Narratives to Follow    
7

sociocultural adjustment (Li and Gasser 2005); international students’

personality development (Ward et al. 2004); and intercultural relation-
ship and students’ well-being (Marginson et al. 2010; Rosenthal et al.
2006).

Factors Influencing International Students’ Decision on Studying

Abroad

There is a considerable body of research on international students’

motives for studying abroad (e.g. Cantwell et al. 2009; Chen 2017;
Lesjak et al. 2015; Nilsson and Ripmeester 2016; Swain and Hammond
2011; Zhang et al. 2013). The “push-pull” model is a much used tool
to analyse and interpret why students choose to study abroad (e.g.
Bodycott 2009; Fang and Wang 2014; Griner and Sobol 2014; Li and
Bray 2007; Mazzarol and Soutar 2002; Wilkins et al. 2013). More
recently, Chen (2017) uses a hybrid of three levels of push-pull dynam-
ics (micro-individual decision making, meso-academic marketing and
macro-national marketing) as the theoretical framework to analyse why
Chinese international students choose to study in Canada.
Pull factors often “operate within a host country to make that coun-
try relatively attractive to international students” (Mazzarol and Soutar
2002, p. 82). Mazzarol et al. (1997) identify six pull factors to influence
students’ selection of a host country: the overall level of knowledge and
awareness of the host country in the students’ home country; personal
recommendations received from the students’ family and friends on the
study destination; the cost related to studying abroad such as fees, living
expenses, travel costs and social costs; the environment of the destina-
tion country (study climate, physical climate and lifestyle); geographic
and time proximity of the potential destination country to the student’s
country; social links referring to whether the student has any links
through family or friends living in the destination country or previously
studying there. Besides, Wu (2014) asserts that the quality of academic
programme, the native English environment and the short duration
of a Master’s programme are important factors influencing mainland
Chinese students’ decision on studying abroad in the UK. Similarly,
8   L. L. Ye

Bridgestock (2014) argues that students choose to study abroad because

they want to study at an internationally reputable university; experience
a new culture and develop intercultural skills; gain benefits from schol-
arships or lower tuition fees. Wei (2013) also argues that university pres-
tige is an important factor influencing international students’ decision
making. Moreover, Cebolla-Boado et al. (2018) find that Chinese stu-
dents are motivated by non-career factors such as university reputation
and a university’s social and cultural offerings in their university choice
in Britain. Furthermore, new life experiences, immigration possibility,
working opportunities and geographic proximity are also identified as
key factors influencing students’ decision making (Bodycott 2009;
Chen 2017; Mazzarol and Soutar 2002).
Push factors are the economic, political and social forces operating
within the source country that initiate a student’s decision to study
abroad (Bodycott and Lai 2012), including factors such as the availabil-
ity of higher education in home country and the fierce domestic com-
petition to get into prestigious higher education institutions in home
country (e.g. Findlay et al. 2012) and enhanced career prospects (e.g.
Chen 2017; Franklin 2010). In addition, Macready and Tucker (2011)
claim that students are motivated to study abroad by factors such as
exploring new culture, gaining experience of living abroad and will-
ingness to travel. In the literature review, Wilkins et al. (2013) discover
that the most common push factors mentioned in publications are
lack of capacity and opportunities in students’ home countries, lower
educational quality, employer preference for overseas education, the
unavailability of particular subjects and political and economic prob-
lems in students’ home countries. Moreover, Chen (2017) argues that
high competition level among students in China and the pressure of
college entrance exam are push factors influencing Chinese students’
decision on study abroad. Furthermore, Martin’s (2017) research on
Chinese female tertiary students’ motivations for choosing to study
in Australia demonstrates that the participants chose to study abroad
to manage gendered risk and fashion a cosmopolitan self. Besides,
push forces also comprise factors such as the improved language skills,
searching for liberty/pleasure and improving one’s social situation
 1 Setting the Scene for the Narratives to Follow    
9

(Bodycott 2009; Bridgestock 2014; Edwards and An 2006; Kelo et al.

2006; Macready and Tucker 2011; Sanchez et al. 2006; Wu 2014).

The Benefits of Studying Abroad

International students not only make tangible economic contributions

to hosting countries and institutions (Harryba et al. 2011; Alghamdi
and Otte 2016), but can enrich the campus culture diversity, and
enhance mutual understanding between students and staff from differ-
ent cultural and ethnic backgrounds (e.g. Lebcir et al. 2008). Alghamdi
and Otte (2016) assert that the increasing number of study abroad stu-
dents has created benefits such as financial gains on the part of hosting
institution, the opportunity for cross-cultural understanding and global
awareness for host institutions and for domestic and international stu-
dents. Moreover, studying abroad is beneficial to students’ language
skills and intercultural learning (Amuzie and Winke 2009; Dewey 2004;
Jackson 2010; Kinginger 2009), personal growth, and intercultural com-
petence development (e.g. Anderson and Lawton 2012; Anderson et al.
2015; Gill 2007; Gu et al. 2010; Jackson 2008, 2011; Mechtenberg
and Strausz 2008; Perry and Southwell 2011). In their review of stud-
ies of the long-term impact of study abroad, Murphy et al. (2014: 3)
identify several benefits, including academic achievement (e.g. Akande
and Slawson 2000), career boost (e.g. Norris and Gillespie 2005, 2009)
and the development of intercultural competence (e.g. Alred and Byram
2005; Chieffo and Griffiths 2004). Moreover, it is established that
study abroad can enhance students’ creativity (Maddux and Galinsky
2009). Paige et al. (2009: 41) research on the long-term effect of stud-
ying abroad finds the positive impact of study abroad on the global
engagement of alumni, who “become civically involved, produce new
knowledge and practice new and environmentally aware lifestyles, make
philanthropic commitments and create or participate in social entre-
preneurship”. In the same vein, Chieffo and Griffiths (2004) study
demonstrates the positive outcome of study abroad in terms of students’
engagement in internationally-oriented leisure activities, and the devel-
opment of intercultural awareness and functional knowledge.
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Von Langenbeck Method.

Busch Method.—The same method as above is employed except

that for the incision A, C, which, upon dissection of the skin in
triangle A, B, C, allows the closure of a larger defect than could be
corrected with the lateral nasal flap alone (see Fig. 426).

Fig. 426.—Busch Method.

The following illustrations are similar to those given and involve

only the skin in the flaps made, as shown. They are only of interest
in portraying the position of the flaps and their pedicles.
Fig. 427.—Dieffenbach Method.
Fig. 428.—Dupuytren Method.
Fig. 429.—Fritz-Reich Method.
Fig. 430. Fig. 431. Fig. 432. Fig. 433.
Sedillot Method.
 Fig. 434. Fig. 435.
Nélaton Method.

In the Bonnet method the flap is taken from the entire thickness of
the upper lip and by twisting is brought into the defect. The pedicle
must be cut at a later sitting.
 Fig. 436. Fig. 437.
Bonnet Method.

Weber Method.—The flap is made from half the thickness of the

upper lip, as shown in Fig. 438, and brought into the defect, as in
Fig. 439. The pedicle is cut later.
 Fig. 438. Fig. 439.
Weber Method.

Thompson Method.—This author uses a lateral flap taken from

the cheek, as shown in Fig. 441, and lines it with a flap of mucosa
dissected from the septum antero-posteriorly, as shown in Fig. 440,
disposing of the latter flap as shown. The raw surface meets the raw
surface of the skin flap, as in Fig. 442.
At a later sitting the two pedicles must be severed and adjusted by
small minor operations.

Fig. 440.—Mucosa flap.

 Fig. 441. Fig. 442.
Thompson Method.

Blandin Method.—The flap is made of the whole thickness of the

lip. The pedicle is cut at a second sitting.
 Fig. 443. Fig. 444.
Blandin Method.

Von Hacker Method.—This author adds a flap from the nasolabial

region to line that taken from the healthy side of the nose, as shown
in the Langenbeck method. There is little cicatrization here, and the
result is excellent for defects of large area.
The procedure and shape of flaps as used are shown in Figs. 445
and 446.
 Fig. 445. Fig. 446.
Von Hacker Method.

Kolle Method.—The author dissects away the flap E, A, D when

part of the mucosa and cartilaginous tissue remains, and where
there is a loss, total or partial, of the alar rima, the transverse incision
E being made as long as required to overcome the defect by sliding,
as in Fig. 447.
The latter flap is freshened at its inferior border along the line D,
and a second or bordering flap of sufficient width to line and face the
nostril is taken up from the upper lip, skin only, as shown in area C.
The lateral or upper flap is now slid down to slightly overcome the
loss of tissue and the flap C is brought upward by twisting slightly on
its pedicle and sutured in place, as shown in Fig. 448.
The secondary wound lying between the lines E and E’,
occasioned by the sliding downward and leaving the triangular defect
F, is allowed to heal by granulation. The lateral flap is fixed along the
line A.
Usually the pedicle of flap C need not be cut, as it adjusts itself
under primary union.
The secondary lip wound is closed at once by suture. The author
has also used the inverted V incision of Dieffenbach, including the
cartilage or part thereof that remains above the defect, and has
moved this flap downward, suturing in Y fashion with good results.
 Fig. 447. Fig. 448.
Author’s Method.

Denonvillier Method.—The operation is similar to that of

Dieffenbach and the author’s modification just mentioned. Its
advantage, as in the latter, is that the inferior border or nasal rim
remains intact, and contains what cartilage remains above the
defect. The shape of the incision is as shown in Fig. 449.
The flap A, B, C includes the skin and such cartilage as can be
used, while the rim below the line B, D retains its lower cicatricial
border.
The flap is slid down until the defect has been overcome, and the
resultant superior triangular wound is allowed to heal by granulation.
The dissection of the flap is made down to the line including the skin
or cartilage referred to. At the dotted line B, D the whole thickness of
the tissue except the overlying skin is involved.
 Fig. 449.—Denonvillier Method.

Von Hacker Method.—The flap A, F, C, as shown in Fig. 450, is

cut from the entire thickness of the side of the nose attached by its
posterior pedicle C.
This flap is moved downward, and its anterior border is sutured
along the freshened line A, B, as in Fig. 451, leaving a triangular
defect, A, F, C.
Two little triangular flaps of skin are dissected up, skin only, at D,
E, C and H, G, C.
Next a rectangular flap, I, K, L, M, is dissected up from the cheek,
as in Fig. 452, including some areolar tissue.
 The flap should be made sufficiently long, so that when folded
over it will fit into the defect without tension, at the same time
allowing for contraction.
This flap is sutured into the defect made by the making of the first
flap, as shown.
The secondary wound of the cheek is brought together by suture,
except for a small triangle near the pedicle to avoid its constriction.
Its raw surface is allowed to heal by granulation. The pedicle is
severed in about fifteen days, and may be cut in triangular fashion to
make it fit smoothly into the slight defect in the skin just posterior to
it.

Fig. 450. Fig. 451. Fig. 452.

Von Hacker Method.
 König Method.—In this novel method a flap somewhat of the form
of the defect is taken from about the entire thickness of the rim of the
ear, as shown in Fig. 453.
This flap should be made slightly larger than the defect, since it
contracts somewhat immediately after excision.
It is sutured rim down to the freshened wound in the wing.
The secondary deformity of the ear is brought together by suture.
The author has found that this cannot be readily done without
puckering the rim when the line of excision is made convexly, and
advises making it triangular instead. The defect of the nose should
be freshened to the same form. The flap from the ear now becomes
ideal, fits better, is more readily sutured in place. No sutures should,
however, be made through the apex of this triangular flap to avoid
gangrene at this frail point. Silk isinglass at this point acts as a splint.
Dry aristol dressings are used.

Fig. 453.—König Method.

 Kolle Method.—When the defect of the ala is elongated and
involves only part of the rim, the author has taken a cutaneo-
cartilaginous flap from the back of the ear.
The flap is cut vertically, and is made to include a strip of cartilage
of about the size and form of the defect.
The flap is immediately sutured to the freshened defect and folded
upon itself with the cartilage facing the inferior margin of the defect.
The flap thus employed exhibits an epidermal face, both inside
and outside as well as at the rim of the wing.
A case in which this method was used is shown in the illustrations
454 and 455, in which the defect is shown in the former figure, and
the result after the sutures were withdrawn on the sixth day in the
latter.
The secondary wound is easily brought together by suture, as the
skin is quite flexible at this point.

Fig. 454. Fig. 455.

Author’s Case.
 Restoration of Nasal Lobule

This defect of the nose has been restored by the use of skin flaps
taken from the forehead, the nose itself, or from half or the whole
thickness of the upper lip. The author does not advocate the use of
such flaps except those taken from the skin of the inner side of the
forearm, just below the wrist, made according to the Italian plan, as
heretofore described.
The pedicle of such a flap is cut about the twelfth day, and at a
later period, when the inferior or free margin has cicatrized, the
subseptum is formed and sutured to the remaining stump or into a
wound in the upper lip made to receive it.
The skin of the forearm is nearer to the thickness of the skin of the
nose; hence a flap from it is preferable to that taken from the arm.
The method of obtaining the flap has been fully described
heretofore.
The results obtained are excellent in most cases. The resulting
cicatrix is barely visible, and may be later improved by scar-reducing
methods, later described under that heading.
The appearance of the flap after the pedicle has been severed and
the subseptal section has been put into place may be observed in
Fig. 456, and the final appearance after total contraction, in Fig. 457.
 Fig. 456.—Flap detached.
Fig. 457.—Final appearance.
Author’s Case.

For very small losses of tissue about the lobule nonpedunculated

skin grafts are to be employed. The author advises including some of
the areolar tissue with them to avoid contraction.
These are to be dressed with the blood method referred to under
skin grafting. Perforated rubber tissue is to be used next to the
epidermal surface to prevent the dressings from tearing away the
graft when changed.
Fine twisted silk is most suitable for suturing purposes. The loops
must not be drawn too tightly and the knot be made so that it rests
upon the healthy skin of the nose.

Restoration of Subseptum
 For the correction of this defect various methods are given, and all
of these must be modified more or less, to meet the requirements or
extent of lost tissue. In some cases the entire subseptum is absent,
while in others there is more or less of a stump remaining. Again in
some, the subseptum required is unusually wide and in others quite
narrow.
While a number of surgeons prefer making the flap to restore it
from part or the whole thickness of the upper lip, as will be shown,
the author believes the best results are to be obtained with the Italian
flap method, if there be great loss of tissue, or to attempt to restore
smaller defects with cartilage-supported nonpedunculated flaps
taken from back of the ear, as heretofore described, or the cartilage
to be used as a support may be taken from the nasal septum itself,
having its pedicle posteriorly.
This strip of cartilage is brought downward, freed at either side
from its mucosal attachment, and the skin flap to be used is then
made wide enough to be sutured to the inferior mucosa margins as
well as to the skin of the lobule.
The method of taking a sliding flap from the healthy skin of the
nose is not advisable, because of the resultant disfigurement.
The tissue of the lip, on the other hand, can be used, since the
secondary wound can be readily drawn together, leaving only a
linear scar. In men, this may be hidden by the mustache.
When the Italian method is used, the method referred to in
restoration of the lobule is to be followed.
Blandin Method.—The flap is taken vertically from the entire
thickness of the upper lip, as shown in Fig. 458, having its pedicle at
the base of the nose.
This strip of tissue is turned upward, mucosa outward, and its
freshened free end is sutured to the raw surface of the lobule.
The secondary wound of the lip is sutured as in ordinary harelip,
as shown in Fig. 459.
 The mucosa soon takes on the appearance of skin, but in most
cases remains pink in color.
The flap taken in this way should not be made too wide.

Fig. 458. Fig. 459.

Blandin Method.

Dupuytren Method.—The flap is taken vertically from the skin of

the upper lip, reaching down at its free end to the vermilion border,
as shown in Fig. 460.
The flap is twisted upon its pedicle and sutured to the skin of the
lobule; to facilitate this the left incision is made higher than that on
the right.
The pedicle may be cut as with all such flaps, and it may be
allowed to remain, if not too disfiguring.
The secondary wound of the upper lip is drawn together by suture,
as shown in Fig. 461.
The mucosa of the nose is to be sutured to the raw edge of the
flap when that is possible.