The bilobed island flap in nasal ala reconstruction.
A bilobed island flap with an extended subcutaneous pedicle including part of the transverse portion of the elevator muscle of the nasal ala is described. This flap was employed for nasal ala reconstruction in 21 patients following excision of malignancy. The series includes 12 females and 9 males ranging in age from 25 to 83 years. In 19 patients, the reconstruction spared the mucosa layer and in two a skin graft was used under the flap to reconstruct the lining. The flap was viable in all cases and the aesthetic outcome satisfactory. The rotation fold dog ear is eliminated. In planning the BIF the length of its lobes (proximal and distal), should be equal to the defect; the width of the proximal lobe, compared to the defect, and the distal lobe compared to the proximal lobe should be progressively narrower.