Trilobed Flap Reconstruction for Distal Nasal Skin Defects

Abstract

The trilobed flap offers a successful reconstructive option for Mohs defects of the distal nose that may not be optimally amenable to bilobed flap repair. Over 3 years, 31 trilobed flap repairs were performed with overall excellent outcomes.

The Medial Based Bi- or Trilobed Flap for Repair of Distal Alar Defects

“…In 2 out of 5 cases the result would have been symmetric with a concave nasal sulcus if the flap had been based medially. This observation is confirmed with their 5th case where a medially based flap was chosen which allowed to create a concave nasal sulcus and complete symmetry [3]. …”

“…Most recent authors have published cases where bilobed flaps and trilobed flaps are pediculated laterally even for alar defects [1,2,3]. This is contrary to the initial article of Zitelli [4] where he insists on the point that laterally based flaps should be used for the distal nasal tip wherefore medially based flaps should be used for alar defects.…”

“…This is unfortunately only rarely possible on the lateral nose. This point is clearly visible for example in the review of Albertini and Hansen [3] where 2 out of 5 illustrated cases show a filled out or protruded alar sulcus and in consequence loss of symmetry which could be prevented with a medially based flap. In 2 out of 5 cases the result would have been symmetric with a concave nasal sulcus if the flap had been based medially.…”

“…Even in elderly patients, the integrity of the patient has to be respected and does not allow arbitrary defect repairs. The literature mentions bi- and trilobed flap reconstructions for defects of the lateral tip of the nose but insists nearly always on the laterally based flap [1,2,3]. A medially based flap is often chosen in large defects of the tip of the nose; medium-sized defects of the lateral tip/ala are generally reconstructed by a laterally based flap although Zitelli [4] recognized already the importance of the medially based bilobed flap in this localization in his first publication.…”

Trilobed flaps: an alternative to dorsal nasal flaps

“…Increasing the angles between arcs can more specifically place the secondary lobe (and tertiary defect) in a more advantageous location but creates a flap that transposes and rotates with greater difficulty, under more tension and a risk of secondary tissue movement and alar distortion. As noted by previous authors, the trilobed flap addresses these very concerns and facilitates flap design with more ideal 45 degrees of rotation per lobe, and with a tertiary lobe oriented perpendicular to the free margin [12].…”