This weeks #reconchallenge was for nasal reconstruction of a sidewall defect.
This was a great opportunity to discuss the bilobed flap.
Our schematic was based on Zitelli's modification.
Lots of flaps being discussed when we set this out on twitter including a cresenteric flap, a superiorly based hatchet flap and a nasolabial V to Y advancement.
-Total transposition limited to 90-100 degrees
-Transpose each flap 45 degrees
-Diameter of each flap is smaller than neighbour
-2nd flap designed to be bisected by vertical axis. In practice, this would be ideal on an RSTL to facilitate primary closure after this flap is transposed.
-2nd flap can be upto twice the height of flap & close primarily.