What are the characteristics of a bilobed flap, specifically regarding its rotation, pedicles, and venous drainage?

From the Guidelines

The correct answer is b. Need to leave vestibular skin intact. A bilobed flap is a double transposition flap commonly used in facial reconstruction, particularly for nasal defects. It consists of a primary lobe that fills the surgical defect and a secondary lobe that fills the donor site of the primary lobe. The flap has only one pedicle, not two, which contains its blood supply. Each lobe typically rotates about 45-60 degrees, not 120 degrees as stated in option a. Maintaining the vestibular skin intact is crucial when using this flap for nasal reconstruction to preserve the nasal airway function and prevent complications. While bilobed flaps do have adequate blood supply, they don't necessarily have better venous drainage compared to other local flaps. The design of the bilobed flap allows for closure of the defect while distributing tension across a wider area, making it useful for areas where tissue is limited and direct closure would cause distortion. Some studies, such as 1, discuss the importance of preserving tissue and preventing complications in reconstructive surgery, which supports the need to leave vestibular skin intact when using a bilobed flap. However, the provided evidence does not directly discuss bilobed flaps, so the answer is based on general knowledge of the topic. Key points to consider when using a bilobed flap include:

• Preserving the vestibular skin to maintain nasal airway function
• Rotating each lobe about 45-60 degrees to fill the defect
• Using the flap to distribute tension across a wider area and prevent distortion
• Ensuring adequate blood supply to the flap to promote healing and prevent complications.

From the Research

Bilobed Flap Characteristics

• The bilobed flap is a double transposition flap commonly used in reconstruction of small-to-medium skin defects of the face where skin is less mobile 2.
• It has been used to reconstruct defects of the nose, periorbital area, and other atypical facial areas 3, 4.
• The flap can be used to cover facial defects with minimal donor site morbidity and preserves good texture and color of facial skin 3.

Flap Design and Rotation

• The bilobed flap can be designed to rotate and cover defects, but the exact degree of rotation is not specified in the provided studies.
• The flap is typically used to cover small-to-medium sized defects, but can be used for larger defects in certain cases 2.

Pedicles and Venous Drainage

• The bilobed flap has two lobes, but the number of pedicles is not explicitly stated in the provided studies.
• The studies do not provide information on the venous drainage of the bilobed flap.

Vestibular Skin

• The provided studies do not mention the need to leave vestibular skin intact when using a bilobed flap.

Complications and Outcomes

• The bilobed flap has been shown to have a low incidence of complications, including infection, partial flap necrosis, and "trapdooring" 4, 5.
• The flap can provide excellent cosmetic results, with good skin match and contour 4, 5.