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- Presentation
Workhorse Flaps: Bilobed
Description
The discussion focuses on bilobed flaps, particularly their indications, performance, and common pitfalls, aimed at both beginner and advanced trainees. The bilobed flap, particularly the modified Zitelli version, is valued for its versatility and effectiveness in reconstructive surgery, especially for smaller to medium-sized defects on the lower third of the nose and other facial areas. Key techniques involve precise flap design, with a focus on undermining the tissue adequately to ensure mobility and tension distribution. Common pitfalls include alar retraction caused by undersized lobes, improper alignment of the closure regarding the anatomical margins, and potential issues like bulldozing or pincushioning due to inadequate suturing or flap sizing. The lecture underscores the importance of meticulous planning and execution in flap design to minimize complications and achieve optimal cosmetic outcomes.
Conclusions
- Bilobed flaps are effective for reconstructive surgery on defects of the lower third of the nose, as well as other facial and hand areas.
- The Zitelli flap variation enhances the original bilobed flap design, allowing for improved cosmetic outcomes.
- Single-stage surgery with bilobed flaps minimizes complications due to matching nearby skin texture and color.
- Bilobed flaps are reliable for small to medium-sized defects (≤ 1.5 cm in diameter) especially when placed 1 cm away from the alar rim.
- Common pitfalls include alar retraction, bulldozing, and pincushioning, which can be mitigated through proper flap design and execution.
- Undermining the flap and adding tacking sutures is crucial to preventing complications during healing.
- Careful measurement and flap sizing are critical to ensure the success of bilobed flaps and prevent aesthetic issues.
- Bilobed flaps can also be adapted (e.g., trilobe flaps) when anatomical considerations demand a more complex approach.
- Ricks et al. Dermatol Surg 2005
- Steele et al. Dermatol Surg 2005
- Jimenez et al. J Hand Surg Am. 2017
- Cook Dermatol Surg 2000