Case 01 2026: Secondary Nasal Sidewall Reconstruction After Prior Bilobed Flap Surgery Using a Surrounding Lateral-Based Trilobed Flap

Keywords: Nasal reconstruction following NMSC, Transposition flaps, Utilizing existing flap as design solution Authors: Frederik Penzien Wainer Mamsen & Lukas Kure-Rosenberg Abstract Background: Secondary nasal reconstruction adjacent to prior local flaps poses unique challenges due to scarring, altered tissue mobility, and potentially unpredictable vascular territories. Although bilobed flaps are considered workhorse techniques in nasal reconstruction, their presence may limit options in recurrent malignancy. Strategic flap planning that respects vascular integrity and aesthetic subunits is therefore essential. Case Presentation: A 74-year-old male patient presented with biopsy-proven recurrent basal cell carcinoma of the right nasal sidewall within a previously reconstructed area using a 180-degree bilobed flap. Tumor excision created an 8 × 11 mm defect abutting the prior reconstruction. Direct closure, secondary intention healing, and skin grafting were deemed unsuitable because of the risk of nasal distortion and alar contracture. Methods: A lateral-based trilobed transposition flap was designed to encircle the prior bilobed flap while preserving its vascular pedicle and redirecting perfusion toward unscarred tissue. The first lobe closed the primary defect, and subsequent lobes redistributed tension vectors. Subcutaneous undermining was performed to preserve the subdermal plexus. Results: The flap demonstrated stable perfusion without ischemia or venous congestion. Healing was uneventful. At 1.5-month follow-up, the patient showed great contour with slight pincushion, preserved nasal symmetry, and a favorable color match. Conclusion: In nasal reconstruction adjacent to prior flap surgery, a lateral-based trilobed flap is a safe and effective single-stage option. Careful vascular planning and tension redistribution enable reliable secondary reconstruction with excellent functional and aesthetic outcomes. Patient medical history Introduction Bilobed flap des