What are the characteristics of a bilobed flap, specifically regarding its rotation, pedicles, and relationship to vestibular skin?

From the Research

The bilobed flap is a transposition flap that consists of two adjacent lobes or flaps that share a single pedicle, not two pedicles, making option C incorrect. Each lobe of the flap can be rotated up to 90-110 degrees (not 120 degrees as stated in option A), with the total arc of rotation typically being around 90-180 degrees 1. The bilobed flap is commonly used for nasal reconstruction, particularly for defects on the lower third of the nose. When performing this procedure, it is important to leave the vestibular skin intact (option B is correct) to prevent contracture and distortion of the nasal airway, as seen in a case report of parotid carcinoma with skin infiltration successfully treated by skin reconstruction with a bilobed flap 2. The flap works by transferring tissue from an area of relative laxity to the defect site, with the primary lobe filling the defect and the secondary lobe filling the donor site of the primary lobe.

The design of the flap should consider tissue elasticity, color match, and contour to achieve optimal cosmetic results. A study on the use of extranasal bilobed transposition flaps in cutaneous reconstructive surgery found that these flaps are versatile and reliable, with minimal postoperative events and good cosmetic outcomes 1. Another study on bilobed flap reconstruction in infraorbital skin defects found that a superiorly based bilobed flap should be selected to avoid ectropion or any distortion in the middle face 3.

Key points to consider when using a bilobed flap include:

• The flap consists of two adjacent lobes or flaps that share a single pedicle
• Each lobe can be rotated up to 90-110 degrees
• The flap is commonly used for nasal reconstruction, particularly for defects on the lower third of the nose
• It is important to leave the vestibular skin intact to prevent contracture and distortion of the nasal airway
• The design of the flap should consider tissue elasticity, color match, and contour to achieve optimal cosmetic results, as supported by studies such as 2, 1, and 3.