Firdous Khan, Ihsanullah Khan, Muhammad Shadman, Zahid Iqbal Bhatti, Tahmeedullah.
Reliability of Zitelli\'s bilobed flap for coverage of small partial thickness defects of the lower third of the nose.
Pak J Surg Jan ;36(4):305-9.

Objectives: To define the use and place of Zitelli`s bilobed flap for reconstruction of small partial thickness defects of the lower third of the nose. Design of study: Descriptive case series Study duration & Setting: Burns & Plastic Surgery Centre, Hayatabad Medical Complex, Peshawar, Pakistan from January 2016 to March 2019. Material and Methods: This descriptive case series study was conducted on 33 patients. Ethical approval was sought and written informed consent was obtained. Detailed history and clinical examination was carried out. Age, gender, site and size of defects were all documented. Inclusion criteria were defects located on distal third of the nose, size < 2cm, no scarring in surrounding nose and non smokers. Photographs were taken. Patients were followed regularly on 5th day for suture removal and then at 3, 6 and 12 months for any complication or recurrence. Results: A total number of 33-patients including 21-male and 12-female were enrolled in the study. Their ages ranged from 23 to 65 years with an average age of 40 years. Causes of defect were basal cell carcinoma in 16 cases, squamous cell carcinoma in 6 cases, pigmented hairy nevi in 4 cases, actinic keratosis in 4 cases and acanthoma in 3 cases. In 13 cases, defects were located on the nasal tip and in 11 cases, defects were located on supra tip area. Nasal alar defects were present in 9 cases. The average size of the defect reconstructed with bilobed flap was 1.7 cm (range 0.5-2.0 cm). The total angle of transferred tissue ranged from 45 to 165 degrees with an average angle of 105 degree. The resultant scars were imperceptible and the color and texture match, contour and symmetry were reasonably good. Post-operative courses were uneventful except in 3 cases that resulted in contour deformities (2 cases) and erythema of scar (1 case). Conclusion: Zitelli`s bilobed flap is a versatile and reliable flap. Its implementation is very easy when selection of patient and wound is carefully done and the principles of technique followed.

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