DOI: https://dx.doi.org/10.18203/2349-2902.isj20222599
Published: 2022-09-28

Bilobed flaps for cutaneous nasal defects: a case series

Abinaya Preethi, Surya Rao Rao Venkata Mahipathy, Narayanamurthy Sundaramurthy, Alagar Raja Durairaj, Anand Prasath Jayachandiran, Suresh Rajendran

Abstract


The bilobed flap is a local flap used for the reconstruction of small to moderate cutaneous nasal defects. It was first described by Esser in 1918 for use in nasal tip reconstruction. It is a double transposition flap where the first flap serves to fill the primary defect, and a second smaller fills the secondary defect. This approach seeks to distribute tension across a wider area. It is a random pattern flap with no specified blood supply. This study was done at the department of plastic and reconstructive surgery, Saveetha medical college and hospital, from January 2018 to December 2018. Five patients (four female and one male) underwent bilobed flap to reconstruct the cutaneous nasal defects out of which three patients had naevus while two patients had basal cell carcinoma nose. Their ages ranged from 35-68 years with a mean age of 52 years. The procedures were done under local anaesthesia. Post-operatively, all sutures were removed on the 5th day. This technique was performed in 5 cases with defect size ranging from 0.9×1.1 to 1.3×1.8 cm. All defects were closed under minimal wound tension, all scars were inconspicuous, no obvious complications occurred, and the aesthetic outcomes were considered favorable. The bilobed flap is a versatile, easy to perform and reliable flap for closure of small nasal cutaneous defects with good aesthetic outcomes, reduced morbidity and less scarring.


Keywords


Aesthetic, Bilobed, Cutaneous Defect, Nose

Full Text:

PDF

References


Zitelli JA, Baker SR. Bilobed flaps. In: Baker SR, Swanson NA, editors. Local Flaps in Facial Reconstruction. St. Louis, MO: Mosby. 1995; 165-80.

Esser JF. Gestielteloakle Nasenplastikmitzweizipfl en Lappen, Deckung des sekundaren Defektesvomersten Zipfeldurch den Zweiten. Deutsche Zeitschriftfür Chirurgie. 1918;143:335-9.

Ramanujam CL, Zgonis T. Use of Local Flaps for Soft-Tissue Closure in Diabetic Foot Wounds: A Systematic Review. Foot Ankle Spec. 2019;12(3):286-93.

Knackstedt T, Lee K, Jellinek NJ. The Differential Use of Bilobed and Trilobed Transposition Flaps in Cutaneous Nasal Reconstructive Surgery. Plast Reconstr Surg. 2018;142(2):511-9.

Grieco MP, Bertozzi N, Grignaffini E, Raposio E. Nose defects reconstruction with the Zitelli bilobed flap. G Ital Dermatol Venereol. 2018;153(2):278-82.

Burget GC, Menick FJ. Repair of small surface defects. In: Burget GC, Menick FJ, editors. Aesthetic Reconstruction of the Nose. St. Louis, MO: Mosby. 1994;117-56.

Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. 1989;125:957-9.

Cho M, Kim DW. Modification of the Zitelli bilobed flap: a comparison of flap dynamics in human cadavers. Arch Facial Plast Surg. 2006;8:404-9.

Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol. 1987;13:1348-53.

McGregor JC, Soutar DS.A critical assessment of the bilobed flap. Br J Plast Surg. 1981;34:197-205.

Bednarek RS, Sequeira Campos M, Ramsey ML. StatPearls Publishing; Treasure Island (FL): Transposition Flaps. 2020

Couceiro J, De la Red-Gallego M, Yeste L, Ayala H, Sanchez-Crespo M, Velez O, Barcenilla R, Del Canto F. The Bilobed Racquet Flap or Extended Seagull Flap for Thumb Reconstruction: A Case Report. J Hand Surg Asian Pac. 2018;23(1):128-31.

Kelly-Sell M, Hollmig ST, Cook J. The superiorly based bilobed flap for nasal reconstruction. J Am Acad Dermatol. 2018;78(2):370-6.