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 45-50 degrees (not 120 degrees), with a total rotation of approximately 90-100 degrees for the entire flap. When designing a bilobed flap, it's essential to leave the vestibular skin intact to maintain the structural integrity of the area being reconstructed and to prevent complications like notching or distortion. The blood supply of a bilobed flap is adequate but does not necessarily provide better venous drainage compared to other local flaps. The main advantage of this flap is its ability to recruit tissue from areas of relative laxity to repair defects in areas with limited tissue mobility, as seen in the study by 1.
Some key points to consider when using a bilobed flap include:
- The flap is commonly used for facial reconstruction, particularly for nasal defects 2
- The flap has only one pedicle, which contains the blood supply 1
- Each lobe typically rotates about 45-50 degrees, with a total rotation of approximately 90-100 degrees for the entire flap
- Leaving the vestibular skin intact is essential to maintain structural integrity and prevent complications 1
- The blood supply of a bilobed flap is adequate, but does not necessarily provide better venous drainage compared to other local flaps 3
In terms of morbidity, mortality, and quality of life, the bilobed flap is a safe and effective option for facial reconstruction, with good aesthetic and functional outcomes, as seen in the study by 4. However, it's essential to carefully design and execute the flap to prevent complications and ensure optimal results.
The most recent and highest quality study on this topic is 4, which highlights the versatility and effectiveness of the bilobed flap in reconstructive surgery. Overall, the bilobed flap is a valuable option for reconstructive surgeons, offering good aesthetic and functional outcomes with minimal morbidity and mortality.