SAS Journal of Surgery Zitelli´S Bilobed Flap for a Nasal Tip Skin

Citation: Jihane Hamdaoui, Samir El Mazouz, Noureddine Gharib, Abdellah Abbassi, Jawad Hafidi. Zitelli´S Bilobed

Flap for a Nasal Tip Skin Defect: A Case Report. SAS J Surg, 2024 Apr 10(4): 435-437.

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SAS Journal of Surgery

Abbreviated Key Title: SAS J Surg

ISSN 2454-5104

Journal homepage: https://www.saspublishers.com

Zitelli´S Bilobed Flap for a Nasal Tip Skin Defect: A Case Report

Dr. Jihane Hamdaoui

, Pr. Samir El Mazouz

, Pr. Noureddine Gharib

, Pr. Abdellah Abbassi

, Pr. Jawad Hafidi

Plastic Surgery Department, Hospital University Ibn Sina, Rabat, Morocco

DOI: 10.36347/sasjs.2024.v10i04.007 | Received: 28.02.2024 | Accepted: 02.04.2024 | Published: 08.04.2024

*Corresponding author: Dr. Jihane Hamdaoui

Plastic Surgery Department, Hospital University Ibn Sina, Rabat, Morocco

Abstract

Case Report

The reconstruction of a nasal skin defect is a challenge for surgeons because it must not only take into account the

functional and aesthetic damage, but also respect the aesthetic subunits. Several solutions exist ranging from primary

closure, skin graft, local or regional flap. In this article, we report the case of a patient who benefited from reconstruction

of a skin defect at the nasal tip using a bilobed Zitelli flap with very good functional and aesthetic results.

Keywords: Skin Defect, Nasal Tip, Bilobed Flap, Basal Cell Carcinoma.

License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original

author and source are credited.

INTRODUCTION

The reconstruction of a nasal skin defect is a

challenge for surgeons because it must take into account

both the functional and aesthetic damage, and also

respect the aesthetic subunits. Several solutions exist

ranging from primary closure, skin grafting, local or

regional flap [2]. The Zitelli’s bilobed flap (ZBF), as a

local cutaneous flap, is possible and suitable for

reconstruction of skin defects of the lower third of the

nose that are 1.5 cm in diameter or smaller [1]. We

describe the case of a patient who benefited from

reconstruction of a loss of skin substance at the nasal tip

using a bilobed Zitelli flap.

CLINICAL CASE

A 68 years old patient presented a nodular basal

cell carcinoma, after resection we had a round and well-

defined skin defect of the nasal tip measuring 1cm in

diameter (figure 1). The procedure was done under local

anesthesia, after doing the markings, the flap was incised

and lifted with the muscle and then transposed (figure 2).

We made sure the hemostasis was good before closing

with simple cutaneous 4/0 stitches (figure 3).

The postoperative course was simple. The

aesthetic and functional results are very satisfactory with

a 6 months follow-up (figure 4).

Figure 1: initial nasal skin defect

Plastic Surgery

Jihane Hamdaoui et al, SAS J Surg, Apr, 2024; 10(4): 435-437

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Figure 2: Bilobed flap lifted

Figure 3: Immediate Postoperative aspect

Figure 4: Aspect after 6 months follow-up

Jihane Hamdaoui et al, SAS J Surg, Apr, 2024; 10(4): 435-437

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DISCUSSION

The bilobed flap was first described by Esser in

1918 for use in nasal tip defect reconstruction, it was a

double transposition flap using two adjacent skin flaps at

90° to one another with a total rotation of 180°, this flap

design produced several complications such as alar

asymmetry [3]. In 1953, it becomes popular when

Zimany made a few changes on the design ensuring a

good cosmetic result [4]. In 1989, Zitelli has introduced

this flap for reconstruction of cases with defects located

on the alar lobules and nasal tip and between 0.5 and 1.5

cm in diameter [5]. The ZBF is using two adjacent skin

flaps at 45° to 55° to one another with a total rotation of

90° to 110°; The lobes are not identical in size, the first

flap is transposed into a defect, and the second (smaller

flap) often designed with an elliptical tip to facilitate

closure is transposed to cover the secondary defect

caused by the larger flap transposition, pivot point for

alar defects is medial while it is lateral for tip defects [6,

7]. The ZBF is especially suitable for the reconstruction

of defects that are 1.5 cm in diameter or smaller, using

skin from the mid dorsum and the sidewall [8], it enables

defect closure with no or minimal distortion of the

surrounding tissues and producing excellent color and

texture match with adjacent tissue [9, 10]. The

disadvantages of the ZBF are that it leaves circular and

vertical scars specially seen in younger patients and

individuals with darker skin tones, they may be treated

by dermabrasion 5 to 6 weeks after surgery if needed [11-

4].

In our case, the ZBF did a proper covering of

the defect, and it left very discreet cosmetic scars. The

patient was very satisfied with the result.

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