Extranasal Applications of the Bilobed Flap

Abstract

The bilobed flap has proven its utility in the reconstruction of distal nasal defects. The mechanics and geometry of the bilobed flap must be clearly understood to achieve these reproducible results. The novelty of the bilobed flap as it is applied to extranasal reconstruction is that the surgeon has some degree of variance in designing the size of the individual lobules of the flap, with a lower risk of secondary tissue distortion. Several variations of the bilobed flap are described, with emphasis on technique and the unique issues involved in its extranasal application. Our experience with the multiple extranasal applications of the bilobed flap is described to demonstrate the usefulness of this reconstructive technique. The general technique of the bilobed flap is described, with emphasis on the extranasal variations. Five anatomic locations are presented, with unique considerations and photographs. The bilobed flap as it is applied to extranasal reconstruction allows the surgeon some degree of variance in designing the size of the individual lobules of the flap (compared with the distal nose), with a lower risk of secondary tissue distortion. The flap must be carefully designed to place the incision lines as close to relaxed skin tension lines as possible. A meticulous suture technique is important in camouflaging the complex suture line of this flap, which in no circumstance completely parallels the relaxed skin tension lines. We hope to expand the use of this versatile flap to extranasal locations. It can produce the equivalent excellent functional and esthetic results compared with its more common nasal application.