Bilobed Flaps 

  • Author: Anthony P Sclafani, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Nov 13, 2011
 

Background

The bilobed flap is a double transposition flap commonly used in reconstruction of facial skin defects. The bilobed flap allows for the movement of more skin over a longer distance than that possible with a single transposition flap. This flap is especially useful when it is applied to facial areas where skin is less mobile (eg, nasal tip, temporal forehead), because it allows for reconstruction of the primary defect with skin of matching consistency and color.

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History of the Procedure

In 1918, Esser first described the bilobed flap to repair nasal tip defects, as seen in the image below.[1] He attributed the increased versatility of the flap to the reduced arc of rotation required by using 2 flaps to reconstruct the defect instead of 1.

Bilobed flap design, as Esser described. Bilobed flap design, as Esser described.

Zimany is generally credited with popularizing the use of the bilobed flap.[2] He defined this as a flap consisting of 2 lobes separated by an angle and based on a common pedicle.

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Indications

The use of a bilobed flap is indicated when the tissue adjacent to a cutaneous defect is insufficiently mobile to close the defect without causing tissue distortion.

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Relevant Anatomy

The bilobed flap is a random transposition flap because its blood supply does not arise from a segmental artery and no defined pedicle is present.

Blood is supplied to the skin via musculocutaneous and cutaneous arteries that perforate subcutaneous tissue. These vessels ascend into the deep reticular and papillary dermis to supply deep and superficial microcirculatory plexus. Rich anastomoses of vessels within these plexus provide blood flow into the most distant portion of the flap.

For more information about the relevant anatomy, see Facial Anatomy in Cutaneous Surgery.

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Contributor Information and Disclosures
Author

Anthony P Sclafani, MD  Director of Facial Plastic Surgery and Surgeon Director, New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College

Anthony P Sclafani, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons

Disclosure: Contura None Board membership; Aesthetic Factors, Inc. Grant/research funds Independent contractor

Coauthor(s)

Andrew Jacono, MD  Chief, Section of Facial Plastic and Reconstructive Surgery, The North Shore University Hospital at Manhasset; Assistant Professor, Division of Facial Plastic Surgery, The New York Eye and Ear Infirmary, New York Medical College; Assistant Professor, Department of Head and Neck Surgery, Albert Einstein College of Medicine; Director, The New York Center for Facial Plastic and Laser Surgery

Andrew Jacono, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory Branham, MD  Vice-Chair, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine

Gregory Branham, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Esser JFS. Gestielte loakle Nasenplastik mit zweizipfligen Lappen, Deckung des sekundaren Defektes vom ersten Zipfel durch den Zweiten. Dtsch Zschr Chir. 1918;143:385.

  2. Zimany A. The bi-lobed flap. Plast reconstr surg (1946). Jun 1953;11(6):424-34. [Medline].

  3. Moy RL, Grossfeld JS, Baum M, et al. Reconstruction of the nose utilizing a bilobed flap. Int J Dermatol. Sep 1994;33(9):657-60. [Medline].

  4. Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. Jul 1989;125(7):957-9. [Medline].

  5. Conner CD, Fosko SW. Anatomy and physiology of local skin flaps. Facial Plast Surg. 1996;4:447-54.

  6. Cook JL. Reconstructive utility of the bilobed flap: lessons from flap successes and failures. Dermatol Surg. Aug 2005;31(8 Pt 2):1024-33. [Medline].

  7. Golcman R, Speranzini MB, Golcman B. The bilobed island flap in nasal ala reconstruction. Br J Plast Surg. Oct 1998;51(7):493-8. [Medline].

  8. McGregor JC, Soutar DS. A critical assessment of the bilobed flap. Br J Plast Surg. Apr 1981;34(2):197-205. [Medline].

  9. Sutton AE, Quatela VC. Bilobed flap reconstruction of the temporal forehead. Arch Otolaryngol Head Neck Surg. Sep 1992;118(9):978-82; discussion 983-4. [Medline].

  10. Zoumalan RA, Hazan C, Levine VJ, et al. Analysis of vector alignment with the Zitelli bilobed flap for nasal defect repair: a comparison of flap dynamics in human cadavers. Arch Facial Plast Surg. May-Jun 2008;10(3):181-5. [Medline].

 
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Bilobed flap design, as Esser described.
Modified design of the bilobed flap.
Bilobed flap procedure performed on a cadaveric specimen.
Bilobed flap procedure performed on cadaveric specimen with the first (or A) flap rotated into the defect.
Bilobed flap procedure performed on cadaveric specimen. The first (or A) flap has been transposed into the original defect. The second (or B) flap has been transposed into the first defect.
Photograph shows a bilobed flap procedure performed on a cadaveric specimen. Both lobes have been sutured in place; standing-cone deformities are shown.
Dog-ear repair after transposition of tissues in the bilobed flap
 
 
 
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