Bipedicled Bridge Flap Reconstruction: A Novel Flap for Functional and Aesthetic Closure on the Nasal Dorsum.

Abstract

Background: Reconstructive options for nasal dorsum defects are limited by poor skin laxity and high aesthetic demands. Few new techniques have been described in recent decades.

Objective: To introduce and evaluate a novel reconstructive method-the bipedicled bridge flap|(BBF)-that combines the reliability of dual-pedicle vascularity with scar concealment along cosmetic subunit boundaries.

Methods: Prospective single-center study of consecutive patients undergoing BBF reconstruction of nasal dorsum defects after Mohs micrographic surgery between June 2021 and June 2025. Defect characteristics, flap variants (unilateral, bilateral, horizontal, or with M-plasty), complications, and aesthetic outcomes using the Manchester Scar Scale (MSS) were recorded. High-quality digital photographs of all defects, repairs, and follow-up to at least 6 months were recorded.

Results: Forty-five patients underwent BBF reconstruction (4 bilateral, 4 horizontal). Mean defect size was 1.7 cm 2 (range 0.3-4.3). No infections, necrosis, dehiscence, hematoma, or hypertrophic scarring occurred. Median MSS = 4, indicating excellent cosmetic results.

Conclusion: The BBF is a novel, reliable, and versatile single-stage option for small-to-medium nasal dorsum defects, expanding current reconstructive algorithms by combining favorable vascularity with superior aesthetic concealment.Cutaneous malignancies of the nose are common and frequently require Mohs micrographic surgery to achieve complete excision. Reconstruction of the nasal dorsum after tumor removal remains one of the most technically and aesthetically demanding challenges in dermatologic surgery. The skin of the nasal dorsum is thin, tightly adherent, and deficient in redundancy, making primary closure difficult without distortion. Positioned at the center of a highly visible cosmetic subunit, even subtle discrepancies in contour, color, or texture can be conspicuous. Successful aesthetic repair, therefore, depends on restoring natural nasal contour, with matching skin texture and symmetry while confining scars within the boundaries of cosmetic subunits.