Primary-lobe-based trilobed and quadrilobed flaps for reconstruction of nasal tip skin defects

Despite a variety of principles proposed for drawing trilobed and quadrilobed flaps for the reconstruction of nasal skin defects, the application of these principles in a detailed and reliable way remains questionable.

We present a novel method for drawing trilobed and quadrilobed flaps to cover nasal tip skin defects. The method is based on the use of templates corresponding to four trilobed flaps with overall angles of 60°, 70°, 80°, and 90°, and two quadrilobed flaps with angles of 90° and 105°. After applying the templates to the surgical field, the most appropriate one is selected to ensure that the donor defect of the last lobe is closed directly within and parallel to the relaxed skin tension lines, whereas the recipient site and the rest of the donor defects are covered by the lobes in a stepwise manner. Flap design is guided by its corresponding template according to clearly defined geometrical steps, ensuring that the vascular base of the primary lobe supports the rest of the lobes as well.

Template-guided flap drawing is an accurate, easy-going, and time-saving process. The base of the flap is the narrowest possible, so the arc of rotation of the flap is the greatest possible. This approach is especially helpful in cases of large tip defects, where the smallest diameter exceeds 2 cm.

The use of templates results in the reliable design of highly effective primary-lobe-based trilobed and quadrilobed flaps (PLBT and PLBQ flaps).