Bilobed flap for nasal reconstruction

Abstract

Commonly used in the reconstruction of facial skin defects, the double transposition bilobed flap is particularly suited for nasal defect reconstruction. Initially described by Zitelli in 1989, the bilobed flap has become the repair of choice for defects in the lower third of the nose (lateral tip, supratip, ala near the tip) measuring between 0.5 and 1.5 cm. By enabling the transposition of skin over a larger distance than would be possible via a single flap, the bilobed flap allows for the use of local tissue well matched in color and texture to the recipient site. Its design is favorable as the secondary defect may be closed primarily with minimization of dog-ear formation. The flap can be designed with its base medially or laterally, best suited for alar or nasal tip defects, respectively. The defect, flap, and surrounding donor site should all be undermined widely in the submuscular, perichondrial, and periosteal planes, in order to facilitate unrestricted flap transposition. This reduces the potential for nasal distortion, pin cushioning, or trap-door deformity.