Island Bilobed Flap With 90-degree Lobe Rotation for Nasal Tip Reconstruction Following Basal Cell Carcinoma Excision

The bilobed flap is a well-established technique for nasal reconstruction and is traditionally designed with limited per-lobe rotation to minimize alar distortion. Island pedicle configurations may allow greater rotational freedom by eliminating cutaneous bridges. We report a case of nasal tip reconstruction using an island pedicle bilobed flap with extended per-lobe rotation. A 75-year-old woman with controlled hypertension presented with a 1 × 1 cm nodular basal cell carcinoma of the nasal tip. Following excision with 6-mm margins under local anesthesia, a 22 × 22 mm supraperichondrial defect was reconstructed using an island pedicle bilobed flap. The primary and secondary lobes were each rotated 90 degrees, resulting in an extended cumulative arc of transposition. The secondary lobe terminated in a tapered acute-angle configuration, allowing tension redistribution without the need for Burow triangle excision. The flap was elevated on a preserved subcutaneous vascular pedicle. The postoperative course was uneventful. At 10-month follow-up, the flap demonstrated complete viability, well-concealed scars along aesthetic subunit boundaries, preserved nasal tip projection, no alar distortion, and high patient satisfaction. The Vancouver Scar Scale score was 0 out of 13. No revision procedures were required. Final histopathology confirmed clear margins, with the closest margin measuring 4 mm. The island pedicle bilobed flap with extended per-lobe rotation represents an effective reconstructive option for selected nasal defects. By eliminating cutaneous bridges, this configuration facilitates tissue recruitment from the nasal dorsum while maintaining reliable vascularity and acceptable aesthetic outcomes. Further studies are warranted to better define its indications and reproducibility.