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The Bilateral Dufourmentel Flap for Repair of Nasal Dorsum Defects After Mohs Micrographic Surgery

Newlove, Tracey MD; Trufant, Joshua W. MD; Cook, Joel MD

doi: 10.1097/DSS.0000000000000641
Original Article

BACKGROUND Single-stage repairs of large nasal dorsum defects risk introducing lower nasal distortion.

OBJECTIVE To describe the authors experience with the “birhombic” flap, a bilateral Dufourmentel rhomboid flap, for repair of nasal surgical defects after Mohs micrographic surgery.

MATERIALS AND METHODS The authors performed a retrospective chart review of patients who underwent birhombic flap repair of the nose by a single physician after Mohs micrographic surgery from 2008 to 2013 at the Medical University of South Carolina.

RESULTS Thirty-eight patients were identified on whom the birhombic flap repair was performed on the nasal dorsum over a 6-year period. There were no significant complications. Alar position remained neutral and nasal profile remained unaltered in all cases. Postoperatively, pulsed dye laser was performed in 8 patients (21%) and dermabrasion in 11 patients (29%). All patients achieved very good or excellent final aesthetic results.

CONCLUSION The birhombic flap is a reproducible, one-stage flap for small to large defects of the nasal dorsum that consistently produces topographic restoration with minimal risk of aesthetic or functional complication. The use of 2 opposing flaps redistributes the secondary defect, thus minimizing the potential for lower nasal distortion when closing the flaps' donor sites.

*Tucson Dermatology Ltd., Tucson, Arizona;

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;

Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina

Address correspondence and reprint requests to: Joel Cook, MD, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 578, Charleston, SC, or e-mail:

The authors have indicated no significant interest with commercial supporters.

This study was approved by the Medical University of South Carolina IRB.

© 2016 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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