Wednesday, March 26, 2008

Bilobed Flap for Repair of Nose

There is an almost bewildering number of reconstructive options from which to select for the nose. The most common etiology of nasal defects that require reconstruction is skin cancer, particularly basal cell carcinoma (BCC) which is the most common nasal skin cancer. It also includes squamous cell carcinoma (SCC) and melanoma. There is a rich history of nasal reconstruction as mentioned in my post last summer.

For loss of skin only, there are some lovely local flaps that can be used. This includes the bilobed flap that was used to reconstruct TBTAM's nose. Some of the folks who left comments mentioned that they couldn't quite imagine "where the skin came from". I hope this helps.

 

The bilobed flap is designed with the long axis of the defect (near the tip of the nose in the picture). Each lobe of the flap is separated by 45° angles. The two lobes of the flap rotate together along an arc with all points on the arc equidistant from the apex of the defect. The larger lobe rotates into the initial defect created by the skin cancer removal. The second smaller lobe rotates into the defect left by the first lobe. A small "triangle" is removed along with the smaller (most superior lobe in picture) lobe so that its defect can be closed as a straight line. The skin that is moved is full thickness. (photo credit)

For additional flaps, check out the eMedicine article listed below.

By the way, TBTAM's nose is looking very nice.

 

REFERENCES

Nasal Reconstruction, Principles and Techniques: Joseph Fata MD; eMedicine Article, April 2, 2006

TBTAM's Mohs Nose Woes Photos, Part I, Part II, and Part III

 

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14 comments:

Eric, AKA The Pragmatic Caregiver said...

You know, I'd actually been puzzling over this myself...thanks for the explanation. I've got a chicken in the fridge that I now feel compelled to try this out on....

(What, you don't try things on dinner first?)

E

rlbates said...

Eric, be sure to wash your hands before and after. :)

sterileeye said...

A lot of skin flap reconstructions/repairs are hard to understand before you see them in action, or get a good explanation like this :)

I'm currently filming surgery for both skin cancers and melanoma, and I think a nose job (the healing kind) is scheduled in a week or two. Should be interesting!

rlbates said...

Sterileeye, I hope you are allowed to post that video. I love the current ones you posted.

sterileeye said...

Thanks!

I'll be sure to post it on my blog when it's been published.

Bardiac said...

Thanks for the explanation! (I'm one of the folks who didn't get it when TBTAM explained at first, but when I saw the picture, and could see the pattern, I got it, and now seeing your diagram, it makes a LOT more sense! Thanks!) (I'm guessing skin is more flexible and stretchy than I tend to think, maybe?)

rlbates said...

You've got it, Bardiac! The skin is flexible.

Femail doc said...

I've had a number of patients go through such surgery for basal cell ca of nose. I appreciate the info on how their noses came out looking so normal!

Eric, AKA The Pragmatic Caregiver said...

Do you make the first lobe exactly the same size as the defect to be closed, slightly smaller, or markedly smaller?

E

rlbates said...

Eric, the first one is the size (or nearly the same size) as the defect. The second is slightly smaller.

TBTAM said...

Wow, thanks for this! My dad is having the same surgery this week, and had expressed the same confusion as to how it works. this is the clearest explanation I've seen to date.

rlbates said...

You are so very welcome! I'm glad I could help. Hope he heals as nicely as you have.

Peter said...

Hi! Considering I'm recovering from a bilobed flap repair of the nose, I found this post extremely informative.

On this occasion Mohs surgery was required after PDT failed to remove the nodular basal cell carcinoma.

Love your handywork!

Take Care,
Peter

rlbates said...

Peter, glad you found it helpful. Thanks