Bending the Arc of the Trilobed Flap Through External Interlobe Angle Inequality

Abstract

BACKGROUND The trilobed flap is a useful repair option for distal nasal defects. In certain cases, however, the placement of its quaternary defect may risk compression of the internal nasal valve or induction of ectropion. In this study, we propose a modified design of the trilobed flap, which uses unequal external interlobe angles. OBJECTIVE To present the design principles and results of our modified trilobed flap for the reconstruction of difficult distal nasal Mohs defects. MATERIALS AND METHODS Mohs defects of 26 patients were reconstructed (21 with long-term follow-up) using our modified trilobed flap over 1 year. Two independent masked raters graded postoperative photographs for alar symmetry and overall cosmesis. RESULTS Median alar symmetry scores were excellent and overall cosmesis grades were between excellent and very good. CONCLUSION The modified trilobed flap with unequal external angles offers an excellent option for reconstruction of Mohs defect of the distal nose that may not be well-suited for other repairs. Over 1 year, 21 modified trilobed repairs were performed with overall excellent outcomes.

Nasal dorsum reconstruction in the cutaneous oncology setting

“…For the reconstruction of dorsum defects, the flap should be designed to place the second lobe vertically in the glabella. When this cannot be achieved, using a trilobed flap to place the third lobe in the glabella is usually a good option (Figure 4 A-C) 10 . The same principles considered in the design and execution of a bilobed flap are applicable in the design and execution of a trilobed flap, with the additional consideration of placement of the third lobe.…”

Reconstruction of an Oblong Nasal Tip Defect

“…The trilobed flap been well characterized and elaborated on; it is versatile and relatively easily executed. 3,4 Relative to a bilobed flap, a trilobed flap mobilizes considerably more skin and minimizes saddle nose deformity, pin-cushioning, and alar asymmetry. 3,4 Although we thoroughly explored variations of the trilobed flap, several challenges were posed by the defect's oblong shape.…”

“…3,4 Relative to a bilobed flap, a trilobed flap mobilizes considerably more skin and minimizes saddle nose deformity, pin-cushioning, and alar asymmetry. 3,4 Although we thoroughly explored variations of the trilobed flap, several challenges were posed by the defect's oblong shape. Our intention in this article is to discuss and illustrate, which illustrates the trilobed flap variations considered and our resolution, our step-wise approach that derived a quadrilobed (Latin, quadri-"4") flap, which is similar to a novel tetralobed (Greek, tetra-"4") flap described by Sutton and Brewer.…”

“…3 The flap was designed around a noncircular arc, similar to a rotational flap (a l á Rieger flap) and a trilobed flap modification. 4 After incising and undermining submuscularly, the flap was inset (See Supplemental Digital Contents 1 and 2, Supplementary Digital Contents 1 and 2, http://links.lww. com/DSS/A654 and http://links.lww.com/DSS/A655, which demonstrates the flap incision and movement intraoperatively) and sutured into place (Figure 3).…”

“…3,4 Relative to a bilobed flap, a trilobed flap mobilizes considerably more skin and minimizes saddle nose deformity, pin-cushioning, and alar asymmetry. 3,4…”