A Retrospective Case Series for the Use of Double Bilobed Flaps as an Alternative to Forehead Flaps for Reconstruction of Small to Moderate Nasal Tip Skin LesionsAuthor: Johnson, Simon. ENT Department Hawkes Bay, Te Whatu Ora.
Introduction: A double bilobed flap is a bilateral transposition flap used for reconstruction following excision of small to moderate nasal tip lesions. Each bilobed flap covers half of the defect and is joined in the midline therefore maintaining symmetry of the nose. This alternative to forehead flaps can be performed under local anaesthetic, in one session, with good cosmetic outcome. Aims: This case series aims to describe double bilobed flaps as an alternative method for reconstructing small to moderate nasal tip defects and explain the potential benefits compared to forehead flaps. |
Presenter: Dr Simon Johnson
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Methods:
The case notes were reviewed of the 13 double bilobed flaps performed by the ENT Department Hawkes Bay between December 2014 until June 2024.
Results:
Of the 13 double bilobed flaps, 12 were done under local anaesthetic. Twelve of the lesions were BCC and 1 was SCC. The diameter of the lesions measured from 7mm to 15mm. The minimum number of patient encounters for a double bilobed flap is 3: excision and flap procedural session, post-op wound review and post-op surgical follow up.
Conclusions:
Double bilobed flap offers an alternative reconstruction method for small to moderate nasal tip lesions with several benefits. The use of local anaesthetic allows for this to be done in the office without an anaesthetic team. This also avoids risks related to general anaesthesia. Double bilobed flap is a single stage reconstruction requiring fewer patient encounters and therefore is more cost effective in a resource limited healthcare system. This procedure could be considered for wider use for small to moderate nasal tip lesions, for defects up to 20mm in diameter.
The case notes were reviewed of the 13 double bilobed flaps performed by the ENT Department Hawkes Bay between December 2014 until June 2024.
Results:
Of the 13 double bilobed flaps, 12 were done under local anaesthetic. Twelve of the lesions were BCC and 1 was SCC. The diameter of the lesions measured from 7mm to 15mm. The minimum number of patient encounters for a double bilobed flap is 3: excision and flap procedural session, post-op wound review and post-op surgical follow up.
Conclusions:
Double bilobed flap offers an alternative reconstruction method for small to moderate nasal tip lesions with several benefits. The use of local anaesthetic allows for this to be done in the office without an anaesthetic team. This also avoids risks related to general anaesthesia. Double bilobed flap is a single stage reconstruction requiring fewer patient encounters and therefore is more cost effective in a resource limited healthcare system. This procedure could be considered for wider use for small to moderate nasal tip lesions, for defects up to 20mm in diameter.
