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A step-by-step guide to performing a laterally-based bilobed transposition flap for nasal tip reconstruction.
This video provides a step-by-step guide to performing a laterally-based bilobed transposition flap for nasal tip reconstruction, a technique commonly used to repair nasal defects following Mohs micrographic surgery. The bilobed transposition flap begins with careful preoperative planning, marking the defect and the adjacent skin flaps to ensure an optimal outcome. The primary and secondary lobes are designed, allowing recruitment of lax nasal dorsum skin and for tension to be distributed evenly across the nasal tissue. The video covers key surgical steps, including incision, flap elevation, transposition, and key suturing. The bilobed transposition flap allows for restoration of nasal tip contours, minimizing aesthetic distortion and preserving nasal function. This educational resource is valuable for surgeons seeking to refine their approach to reconstructive surgery of the nasal tip.
Bilobed flaps are adjacent tissue transfers and can be often completed in the outpatient setting immediately after confirmation of clear margins utilizing the Mohs micrographic surgery technique. Patients can be awake or under sedation. Local infiltration of 1% lidocaine with 1:100,000 epinephrine provides adequate local anesthesia.
A standard surgical closure tray is used.
Repairs of the nasal tip aim to restore nasal tip projection, contour, and matching skin quality while avoiding nasal asymmetry or decreased nasal function. This video shows a typical healing time post-operatively where the flap and skin is erythematous and raised but improves over 1-2 months to restore an expected and excellent cosmetic outcome. Nasal function is maintained.
With any repair there can be more than one acceptable solution. Healing by secondary intent could achieve a reasonable result with less surgery, however, the nasal tip contour is often diminished after granulation. A full thickness skin graft can be utilized such as a Burow's graft from adjacent superior skin. Skin grafts may take longer to heal and may result in a mismatch of color and skin texture. A dorsonasal rotation flap such as the Rieger Flap may be an adequate approach for this defect but requires a different execution. A linear closure can be considered but this defect was too large for a linear primary closure and would result in flaring of the nares with possible alar notching upon closure and subsequent healing.
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Miller CJ. Design principles for transposition flaps: the rhombic (single-lobed), bilobed, and trilobed flaps. Dermatol Surg. 2014;40 Suppl 9:S43-S52. doi:10.1097/DSS.0000000000000115
Rohrer TE, Bhatia A. Transposition flaps in cutaneous surgery. Dermatol Surg. 2005;31(8 Pt 2):1014-1023. doi:10.1111/j.1524-4725.2005.31826
Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. 1989;125(7):957-959.
Review Bilobed transposition flap for nasal tip reconstruction.