The hatchet and bilobed flaps revisited: shedding new light on traditional concepts.
BACKGROUND
The bilobed and hatchet flaps are well-accepted reconstructive options for the correction of defects of the lower third of the nose. Optimal utilization of these flaps depends on understanding the characteristics of each flap as well as anatomic considerations related to the distal nasal area. Disregarding the limitations of either method may lead to flap failure and unacceptable aesthetic results.


OBJECTIVE
We present three original ideas: 1) a bilobed flap may be considered as a hatchet flap with a Z-plasty; 2) the trap door deformity (TDD) associated with a bilobed flap can be used as an advantage; and 3) an easy method for preoperative planning of a bilobed flap.


METHODS
We collected data from patients who underwent excision of basal cell carcinoma (BCC) of the distal third of the nose and reconstruction with a hatchet or a bilobed flap within the last 20 years.


RESULTS
Favorable cosmetic results were achieved when a hatchet flap was used to reconstruct defects of the inferior third of the nasal side wall, above or bordered with the alar crease, and when a bilobed flap was used to reconstruct nasal tip para-medial defects above the lower lateral cartilage convexity.


CONCLUSIONS
We suggest choosing between the hatchet and bilobed flaps for nasal reconstruction according to the defect location as outlined by our findings.
Mohs Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Isaac
I
Zilinsky
Nimrod
N
Farber
Josef
J
Haik
Oren
O
Weissman
Tal
T
Friedman
Eyal
E
Winkler
D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015580:Mohs Surgery / Q000009:adverse effects / Q000639:trends; D009666:Nose / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000706:statistics & numerical data*