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Nose Reconstruction - Bilobed Flap in a Patient
With Basal Cell Carcinoma
This flap is a combination between a rotation
advancement and nasal labial flap. The flap is comprised of two lobes,
each positioned at an angle of 45 to 60 degrees, which are rotated to fill
corresponding defects. Each lobe is slightly smaller than the defect it fills.
The prominent "dog ear" and distortion of the nostrils, which can occur with a
nasal labial flap are less likely to occur with a bilobed flap. The
bilobed flap is useful in reconstructing nasal alar defects of 1.5 cm or less.
Keeping the angle of the lobes at 45 degrees minimizes tissue protrusions.
The final lobe should be positioned on the border of the facial aesthetic
subunit, between the nose and the cheek.
View Abstract
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Preoperative appearance of the nasal lesion. On biopsy, this was found to be a basal cell carcinoma.
The nasal defect after Mohs excision.
Surgical Plan. Each lobe is at approximately a 45 degree angle and each is slightly smaller than the defect it fills. Note the defect of the last lobe is closed primarily and is placed at the junction between the cheek and naris.
Depending upon where the defect is the lobes may vary between 45 to 60 degrees.
Appearance of the operative closure.
Postoperative appearance 2 days after surgery.
Postoperative appearance seven days after surgery.
Postoperative appearance seven days after surgery.
Inferior view, note that the nostrils are not distorted.
Postoperative appearance 22 days after surgery.
Oblique view, note that the nostrils are not distorted.
Postoperative appearance 22 days after surgery.
Lateral view, note that the left nasal alae is not distorted.
Postoperative appearance four months after surgery.
Lateral view, note that the left nasal alae is not distorted.
Postoperative appearance four months after surgery.
Anterior view, note that the left nasal alae is not distorted.
