The bilobed flap for reconstruction of distal nasal defect in Asians

The aim of this study was to overcome nasal alar retraction that occurs with the use of the standard Zitelli's bilobed flap for reconstruction of a distal nasal defect. Zitelli's bilobed flap offers the ability to aesthetically reconstruct difficult defects in the distal nasal area. However, the standard Zitelli bilobed flap may sometimes result in nasal alar retraction which is likely to the result of excessive tension upon closure of the primary lobe and primary defect.

We modified the bilobed flap based on the design of the standard Zitelli bilobed flap. The modification of the bilobed flap was designed to have a primary lobe that was 10% longer than the length of the distal defect edge from the flap's pivot point, and the width of the primary lobe was equal to the width of the defect. The length of the secondary lobe was 130% of the length of the distal defect edge to the flap's pivot point, and the width of the secondary lobe was two-thirds the width of the primary lobe. To make a slight downward displacement of the ipsilateral alar margin, the primary lobe was transposed to fill the primary defects.

The results of the reconstruction were satisfactory: there was good nasal contour and appropriate symmetry of the nasal tip and no alar retraction.

The modification of Zitelli's bilobed flap to have a longer primary lobe, which slightly displaced downward the ipsilateral alar margin intraoperatively, can prevent nasal alar retraction in the reconstruction of distal nasal defects in Asians.