From the Research
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 the blood supply. Each lobe typically rotates about 45-60 degrees (not 120 degrees as stated in option a), with a total rotation of approximately 90-110 degrees for the entire flap. The vestibular skin must remain intact to maintain the blood supply to the flap, as the flap relies on a single vascular pedicle. While bilobed flaps do have adequate venous drainage, they don't necessarily have better venous drainage compared to other local flaps. The main advantage of a bilobed flap is its ability to recruit tissue from areas of relative laxity to repair defects in areas with limited tissue mobility, while distributing tension across multiple tissue planes, as described in the study by 1.
Some key points to consider when using a bilobed flap include:
- The importance of accurate mathematical measurement in designing the flap, as discussed in the study by 1
- The role of the pivot point in determining the movement of the flaps, as described in the study by 1
- The potential for modification of the classic design to improve the precision of the flap, as discussed in the study by 1
- The use of bilobed flaps in reconstructing defects in areas other than the face, such as the forearm, as described in the study by 2
Overall, the bilobed flap is a versatile and effective tool in reconstructive surgery, and its use should be considered in a variety of clinical scenarios, as supported by the studies by 3, 2, 1.