This 68-year-old Caucasian man was referred for Mohs surgery of a basal cell carcinomma on the nose. The resultant defect was repaired with a bilobed flap.
The bilobed flap is a double transposition flap that affords a practical means of repairing nasal surface defects smaller than 1.5 cm in diameter. Initially described with an arc of rotation of 180 degrees, the Zitelli modification confines the total arc of rotation to 90 to 110 degrees.
The diameter of the first lobe is designed equal to that of the defect. The diameter of the second lobe is decreased to aid in donor site closure. Wide undermining in the submuscular plane is necessary to mobilize the flap. Each lobe should not rotate more than 50 degrees.
Lateral based flaps are performed to fill defects on the nasal tip, and medial based flaps are employed for defects on the ala. Efforts to allign the resultant scar lines at the borders of the nasal subunits will result in superior cosmetic outcomes.