The superiorly based bilobed flap for nasal reconstruction

Background: The laterally based bilobed flap is commonly used for the reconstruction of small-to medium-sized defects of the distal portion of the nose; However, when this flap is used to repair defects that are larger, more cephalic, or more lateral on the nose, there is a risk for lower nasal distortion. Reorienting the base superiorly preserves the advantages of the traditional design while minimizing this risk. Objective: To demonstrate the design, execution, and efficacy of the superiorly based bilobed flap. Methods: A retrospective review examined all superiorly based bilobed flaps performed by 1 surgeon (J. C.) in 2000-2016 after tumor extirpation by Mohs micrographic surgery at a single institution. Results: A total of 41 surgical defects were closed with 40 flaps between June 2000 and August 2016 (1 patient had 2 defects closed with a single flap). Of the tumors, 55% were located on the nasal dorsum, and the median of the longest postoperative tumor axis was 1.4 cm. Follow-up was available for 40 flaps, and no infections, hematomas, or episodes of full-thickness necrosis were observed. Limitations: Data were collected retrospectively from a single institution without a standardized assessment tool for aesthetic outcomes. Conclusion: The superiorly based bilobed flap is useful for nasal reconstruction.