Zitelli Modificatation Of The Bilobed Flap

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.

Key points

-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.

Happy learning!

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