Since it's original description in 1918, the bilobed flap has undergone step-wise improvements in design to increase arc of rotation and indications. The Zitelli-modification is the most commonly used currently. The bilobed flap was described by Esser in 1918 15. He used this flap for nasal tip reconstruction Akita and Chiba, Japan. Naoshige Iida, M.D. Department of Plastic and Reconstructive Surgery. Akita Red Cross Hospital. 222-1 Yonashirozawa, Saruta, Kamikitat The bilobed flap is useful for the reconstruction of skin defects in which the primary closure is difficult. Proper design is paramount to achieve excellent cosmetic results, but flap design often appears unnecessarily complex and difficult
The bilobed flap is useful for the reconstruction of skin defects in which the primary closure is difficult. Proper design is paramount to achieve excellent cosmetic results, but flap design often. Resection of benign lesions is a common cause of nasal defects in young patients. The conventional bilobed flap (Zitelli's design) used for reconstruction of defects of the lower third of the nose traditionally utilizes skin from the mid dorsum and the sidewall of the nose. [ 1 The design of the bilobed flap is based on a geometrically configured pattern that spans a 90° pivotal arc. The first step in the proper design of this flap is to mark the 2 arcsthat will define the boundaries of the flap and its proper angulations. In order to do so, the radius and diameter of the nasal defect are measured with calipers The Bilobed Flapfor Nasal Reconstruction John A. Zitelli, MD \s=b\Four hundred consecutive surgical wounds on the nose were studied for wound management. The most commonlyused flapwas the bilobed double transposition flapthat is especiallyuseful for reconstruction of defects on the lower third of the nose. While the standard design often results in tissue protrusions or pincushioning
Background: The laterally based bilobed flap is commonly used for the reconstruction of small- to medium-sized defects of the distal portion of the nose; However, when this flap is used to repair defects that are larger, more cephalic, or more lateral on the nose, there is a risk for lower nasal distortion Objectives: This paper describes imaging and anatomical features, in order to assess the feasibility of superficial circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients. Methods: A total of 7 pediatric patients who were being treated with free single-pedicle bilobed SCIP flap reconstruction.
The bilobed flap has a high flexibility of flap design variation and tissue movement. Esser stated that the angle of tissue transfer had to be 90 degrees.1 However, subsequent authors have found that the angle can be decreased significantly to suit the situation.7 The chosen angle has effects on tension vectors A standard-design Zitelli bilobed flap was used to close the nasal and cheek defects on 1 side of each specimen (n = 6). The contralateral defect was closed with a modified design in which the primary flap was either 10% longer (n = 3) or 10% shorter (n = 3) than the standard primary flap as measured from the pivot point Surgical method. A soft-tissue release was performed in each case 5 with a dorsal or volar bilobed flap to transpose the excess ulnar-sided soft-tissue to the radial side of the wrist. The technique, in brief, is the identification of the point of maximal skin deficiency on the radial side of the ulnocarpal articulation
A bilobed flap is often used in cases where single-stage plication of skin defects is not recommended. 5-7 In 1999, we devised a novel rational method to design a bilobed flap. 1 Our design enables the tension on the flap to disperse almost uniformly while allowing blood flow to stabilize. 1-4 To date, we have successfully performed this. The lessons learned from decades of bilobed flap experience, and now years of trilobed flap use, have created a flap with predictable tissue movement and outcomes. As noted, patient and defect selection are crucial, however with optimal flap design and execution, the trilobed flap can reconstruct lower nasal defects as an alternative to the. The lessons learned from decades of bilobed flap experience, and now years of trilobed flap use, have created a flap with predictable tissue movement and outcomes.As noted, patient and defect selection are crucial, however with optimal flap design and execution, the trilobed flap can reconstruct lower nasal defects as an alternative to the dorsa
bilobed flap: flap designed with segments, A and B, so that flap A rotates into the recipient defect, flap B closes the defect left by flap A, and the flap B donor site is closed primarily. Usually designed as a rotation flap and employed where donor tissue is scarce. Because flap B closes flap A's donor site, the true donor defect is moved. Bilobed flap design in nasal reconstruction Steven Mobley, MD Figure 1. Preoperatively,thedefect isseen on thesupranasaltip. The use of a bilobed flap is a practical means of repairing surface defects of the nose that are smallerthan 1.5 ern in diameter. This repair is a one-stage reconstruc tion procedure that can be performed with local. A standard-design Zitelli bilobed flap was used to close the nasal and cheek defects on 1 side of each specimen (n = 6). The contralateral defect was closed with a modified design in which the. Aim: The correction of nasal tip defects presents many challenges. Zitelli's bilobed flap has been widely used for such repairing defects, but may be complicated by interrupted scars on the nasal dorsum. Our study evaluates the design principles, results, and advantages of a modified bilobed flap for repairing nasal tip defects. Methods: The primary lobe was located between the defect and the. In 1918, Esser described the use of the bilobed flap, a random pattern flap for reconstruction of nasal tip defects [ 6 ]. Esser's original design required that the angle of tissue transfer be 90º between each lobe of the flap for a total pivotal movement of 180º [ 6 ]. This design maximizes the distance that the skin can be moved
Background. Although the bilobed transposition flap's utility in the reconstruction of difficult facial surgical wounds is often praised, the complicated design of the flap can produce unacceptable.. traditional bilobed flap. (C) This surgery resulted in a cosmetically and functionally good outcome at a 5-month follow-up. tropion and deformities of the eyelid margin1. This leads to difficulties in properly designing local flaps1,2. Bilobed flaps are a double transposition flap using relatively loose tissue, mainly from the glabella or nose3.
circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients. Methods: A total of 7 pediatric patients who were being treated wit h free single-pedicle bilobed SCIP flap reconstruction for multi-digit defects were included in this study The rhomboid flap is a local transposition flap - a flap that moves laterally about a pivot point into an adjacent defect. This lateral movement differs it from a rotation flap. The donor site wound is closed directly under minimal tension. Other examples of transposition flaps include: Bilobed Flap. Z-plasty A bilobed flap with the first lobe at 80% of the defect at a 30-40 degree angle and the second lobe at 80% of the donor site at a 90 degree angle to the original lesion. These were elevated using sharp and blunt scissors dissection. Dissection was then used to elevate the skin around the margin. Cautery was used to control bleeding ↑ Turan T, Kuran I, Ozcan H, Bas L. Geometric Limit of Multiple Local Limberg Flaps: A Flap Design. Plast Reconstr Surg 1999;104:1675-8. ↑ Iida N, Ohsumi N, Tonegawa M, Tsutsumi K. Simple method of designing a bilobed flap. Plast Reconstr Surg 1999; 104:495-9. ↑ 32.0 32.1 Sullivan TJ, Bray LC. The bilobed flap in medial canthal. Best answers. 0. Jun 2, 2021. #7. Bilobed flaps are ATT/Transposition flaps (14XXX series) though, and based on the size of the defect not the flap (s) per CPT. So you're saying if the defect is 30sq cm, and the bilobed flap requires two flaps (one to close the defect, one to close the skin 'donor' site), then double the defect size to 60 sq cm.
eyebrows, limit ﬂap design, as does the lack of signiﬁcant horizontal tissue redundancy in this region. Several ﬂap designs adequately reconstruct the medial canthal region, including the glabellar ﬂap, the rhomboid ﬂap,1,2 the V-Y advancement ﬂap,3,4 and the bilobed ﬂap.5-7. The bilobed flap is modeled into the defect with multilayer sutures. Complication(s) This section has been translated automatically. Pincushioning, scar retraction (trapdooring): The pincushioning can be treated with intralesional corticosteroids. Prevention: correct flap design, extensive undermining, careful subcutaneous suturing technique. This led to difficulties in designing a suitable flap for reconstruction of the defect due to its location and a risk of ectropion. Therefore, an incomplete traditional bilobed flap was designed to reconstruct the lower eyelid defect using upper eyelid tissue ( Fig. 1B )
- Rhombic Transposition flap - Bilobed transposition - Nasolabial transposition -The design of this flap displaces a Burow's triangle from the nasal tip to the glabella along an incisional arc that extends from the more inferior aspect of the defect (above the alar crease) to the nasofacial sulcus and finally onto the glabella. MacGregor and then Zitelli modified the bilobed flap (see Figure 4-10). Their geometric design rotates the flap through 90 to 100 degrees and incorporates a dog-ear excision without diminishing vascularity. It is useful for defects measuring 0.5 to 1.5 cm in the inferior nose A prototypical bilobed flap on the nose involves several unique features: Greater movement about the pivot point because of its position near the recruitable medial cheek. Double transposition design displacing the tension vector away from the primary defect. Lengthening effect of the Z-plasty to overcome pivotal restraint
Proper design of the bilobed flap along with extensive undermining usually ensures that this nostril flaring does not occur, but with large defects, this can sometimes be inevitable. Usually 1-2mm of nostril flare will relax itself in a few months. If it does not, it can be challenging to fix.. Fig. 5 a A 62-year-old woman with recurrence of squamous cell carcinoma on the nasal tip. b The design of Zitellis bilobed flap for reconstruction of the wound after tumor excision using the Mohs surgical technique. c The wound was reconstructed using a bilobed flap without nasal alar margin displacement. Early postoperative view. d Three months postoperative view shows left nasal alar.
In 1989, Zitelli described a modified version of the bilobed flap design technique using 45° and 90° angles to improve nasal reconstructions. While the bilobed flap is still frequently referenced in scholarly literature, there seems to be inconsistency in preoperative flap design; these deviations can lead to suboptimal outcomes Bilobed flaps are extremely reliable when used properly. Given proper flap design, partial or complete failure is unpredictable. Flaps designed with large length-to-width ratios increase the likelihood of distal compromise because of the limited ability of the microcirculation to adequately perfuse the distal flap Results: The bilobed flap was employed in oncological surgery in 93% of the cases while the skin of the head was involved in 71%.The post operative period was free of complications in 85%. Infection rate was 4.4%, trapdoor scaring rate was 4.4% and partial flap loss rate was 11.1%. The overall complication rate was 15%
Objective: A new bilobed design of the sensate radial forearm flap is presented for reconstruction of the oral cavity following significant glossectomy. One lobe of the flap is used to restore the shape and volume of the tongue, while the second lobe is used to resurface the floor of the mouth and the gingiva The bilobed flap is a simple design and a single-stage procedure. The design of the bilobed flap for nasal reconstruction typically follows Zitelli's design at present. However, the main reported disadvantage of Zitelli's bilobed flap is distal flap tension resulting in nasal alar retraction
Flap coverage is usually a concomitant procedure, which improves the quality of the skin overlying the distal interphalangeal joint. We propose the Zimany bilobed flap in this indication, and particularly its newer geometric design developed by Zitelli. We report the use of this flap in 9 cysts. Wound healing was fast with a good outcome . This flap design is classically used for defects on the lower third of the nose, and it can be useful for a large defect of the cheek when a simple rotation flap will not provide enough tissue for adequate coverage (figure 2, B and C)
The bilobed flap consists of two lobes based on a single pedicle and has the advantage of recruitment of more mobile tissue with more favorable tension vectors. Zitelli's modified bilobed uses 45-degree angles (rather than 90-degrees in Esser's design), minimizing dog-ears (tissue protrusion) and pincushioning The malar skin is undermined to create a flap that is raised and secured with deeply placed braided nonabsorbable sutures such as 3-0 TiCron™ (Covidien, Mansfield, MA) at the level of the temple. Closing the gap laterally facilitates approximation of the edges of the original defect while alleviating tension on the lower-eyelid skin, thereby. Background. The bilobed flap is a useful tool for reconstruction of the nose but is occasionally complicated by pincushioning or trapdoor deformity. Objective. To describe the use of a rhombic bilobed flap for use in reconstructing defects on the lower third of the nose. Methods. Reconstruction of skin cancer defects following Mohs surgery was performed using a bilobed rhombic flap design in.
Conclusion: This flap is versatile, reliable and easy to implement especially when the principles of technique, patient and wound selection are carefully applied. Keywords: Small nasal defects, Nasal reconstruction, Bilobed flap, Zitelli's bilobed flap (ZBF). INTRODUCTIO Extranasal applications of the bilobed flap. The novelty of the bilobed flap as it is used for extranasal reconstruction is that the surgeon has some degree of variance in designing the size of the individual lobules of the flap, with a lower risk of secondary tissue distortion The bilobed flap has a high flexibility of flap design variation and tissue movement. Esser 1 stated that the angle of tissue transfer had to be 90°. However, subsequent authors 7 have found that the angle can be decreased significantly to suit the situation
These techniques mainly use local skin flaps from the preauricular, infraauricular, retroauricular and retromandibular areas or the auricular surface depending on the flap design. Doubled-over single or bilobed flaps and superimposition of two opposing or paired flaps or double-crossed flaps may be used; some techniques require a split. 4-How to design a bilobed flap? Below, you will find a simply step-by-step description of the Zitelli bilobed flap. The whole concept of the bilobed flap design is based on a geometrical pattern that spans a 90°-100° pivotal arc. To achieve desirable results, it is crucial to properly define the boundaries and angulation of the lobes of the flap The bilobed flap has a high flexibility of flap design variationandtissuemovement.Esser1 statedthattheangle oftissuetransferhadtobe90°.However,subsequentau-thors7 have found that the angle can be decreased sig-nificantly to suit the situation. The chosen angle has ef-fectsontensionvectors.Thedirectionofvectoralignmen This unique design combines the Z plasty and the bilobed flap designs. At first glance, the center red and blue flaps look like a Z plasty, but look how far apart they wind up. This flap takes advantage of the unique geometry of the interdigital web
Bilobed flaps may be used anywhere on the cheek; however, care should be taken in using the flap because not all the incisions required to create the flap lie parallel to the natural lines of the face, and the aesthetic result could be disappointing. The flap is best used to repair large to moderate-sized defects of the central cheek Due to the high lexibility and freedom of movement of the lobes, the bilobed design has been demonstrated to be versatile, reliable technically practical in microsurgery  and provides good cosmesis. Conclusion In summary, we presented a case report demonstrating the application of the bilobed lap in the medial canthal reconstruction BILOBED FLAP • It is used in case of circular lesions • Circular lesion is excised • First flap is marked which is ¾ to the diameter of the lesion. Second flap is of ½ to ¾ to the diameter of the lesion and incised • Flaps and the edges of the lesion are undermined widely Bilobed flaps Another variation of transposition flap 2 transposition flaps sharing common pedicle First flap used to reconstruct defect ;second used fordonor site defect 24. Interpolation flaps Similar to transposition flap Difference is..pedicle rest over intervening tissue Pedicle divided and inset at second stage afterrevascularization E.g. This bilobed flap design could improve the arc of flap rotation and the mobility of the flap so it could cover wide and deep defects. Moreover, it could preserve the characteristics of each triangle. METHODS: This study enrolled a total of 15 female patients who had undergone perineal reconstruction with pudendal artery perforator flaps
If there is a larger defect, however, a physician may have to create a flap from tissue more distant from the surgical site (from the wrist, for example) to get a large enough piece of skin. Rarely, a 'free flap,' is needed, which involves sewing blood vessels back together to reestablish blood flow, Dr. Antell explains V-Y plasty: An adjacent tissue transfer technique where incisions are made in a shape resembling the letter V to create a flap that is then advanced (moved from one position to another) to repair a defect. The final repair which includes a straight line of sutures to repair the area where the flap came from and two additional lines of sutures. The bilobed flap is a random flap but is excellent for coverage of various surgical defects throughout the. Figure 4-10. A, The patient had undergone excisional biopsy of a malignant melanoma of the cheek elsewhere. The scar of previous excision was widely encompassed in the surgical incisions which were planned to provide access for a superficial parotidectomy Answer: Scar Gel. In general, thick scars respond best to simple massage and/or application of soft silicone gel sheeting such as EpiDerm. This is available from Amazon for about $7. Any such treatment will take several months. A quicker option would be intralesional injections with a steroid such as Kenalog
INTRODUCTION. The bilobed flap was first described in the German literature in 1918 by Esser 1 as an ideal structure for closing defects in the nasal tip. However, it became popular in 1953 when Zimany 2, a plastic surgeon at the University of New York, published a description of this flap in the English literature.The bilobed flap is a double transposition flap with a single pedicle in which. Multiple options exist including wedge excision, helical rim advancement flaps, bilobed flap, and grafts, to name a few. Wedge excision of the ear may result in a noticeable anteverted, smaller ear, and disrupts auricular cartilage with the possibility of chondritis and excess pain. Helical rim advancements can result in anteversion of the ear.
The bilobed platysma myocutaneous flap is significantly different with traditional platysma myocutaneous pedicle flaps (Imanishi et al. 2005). There are four design of platysma myocutaneous flap, including superiorly based flap, inferiorly based flap, and posteriorly based flap. The posteriorly based platysma myocutaneous flap which ha Besides the classical bilobed flap, there are different modifications available. In 1989, Zitelli adapted the design of Esser's bilobed flap by reducing its rotation angles.5 It is designed to move more skin, without deformation, over a larger distance than it would be possible with a single transposition flap in the same location
the bilobed flap offers distinct advantages over alternative repairs: access to an adjacent tissue reservoir with similar aesthetic qualities, predictable flap viability, and the reduced morbidity of a single-stage procedure.3 In the traditional design, the vascular inlet, or base, of the bilobed flap is located laterally, where tributaries of. 1.0 cm and secondary defect for flap design of 2.0 cm X 1.0 cm. -1.0 sq cm + 2.0 sq cm = 3.0 sq cm • Rotation flap performed with primary defect from excision 1.0 cm X 1.0 cm and secondary defect for flap design 2.5 cm X 1.2 cm -1.0 sq cm + 3.0 sq cm = 4.0 sq cm Adjacent Tissue Transfer 37 These photos are actual untouched images of people who have received reconstructive surgery by Dr. McIver Leppard. Before Ear Reconstruction. After Ear Reconstruction. Before Bilobed Flap. 6 Months After Bilobed Flap. Before Photo Scalp Flap. One Month After Scalp Flap. before. after Bilobed flap may be used to reconstruct mayor defects in different anatomical regions. Due to the high flexibility and freedom of movement of the lobes, the bilobed design has been demonstrated to be versatile, reliable technically practical in microsurgery  and provides good cosmesis