Superiorly Based Bilobed Flap for Inferior Medial Canthal and Nasojugal Fold Defect Reconstruction

Abstract

To evaluate the use of a superiorly based bilobed flap for reconstruction of nasojugal fold region defects. Retrospective review of all patients undergoing medial canthal, nasal sidewall, and nasojugal fold region reconstruction using a superiorly based bilobed flap from October 2000 through March 2008. Charts were reviewed for patient age and gender, indication, defect size and location, flap(s) used, and follow-up time. Outcome measures included ability to completely close the defect with minimal tension, cosmetic appearance, complications, and need for further surgery. Eighteen cases of medial canthal and nasojugal fold area reconstruction were performed using a superiorly based bilobed flap in 17 patients. There were 8 male and 9 female patients with an average age of 68.2 years (range, 11-88 years) and mean follow-up time of 17.8 months (range, 1-60 months). Mean defect size measured 2.0 x 1.4 cm (range, 0.7-4 cm). One patient underwent simultaneous glabellar flap repair, 2 patients underwent simultaneous lateral lower eyelid rotational flap repair, and 1 patient underwent simultaneous upper eyelid V-Y advancement flap. All defects closed completely with no wound tension. No cases of hemorrhage, infection, dehiscence, or necrosis developed during the follow-up period. Cosmetic satisfaction occurred in 16 of 17 patients. Complications included mild medial ectropion (2 patients) and canalicular stenosis (1 patient). None of these patients elected reoperation. Trapdoor deformity did not occur in any case. Two patients underwent reoperation for local tumor recurrence. A superiorly based bilobed flap adequately reconstructs inferior medial canthal, nasal sidewall, and nasojugal fold defects.