Bilobed Flap Research Articles

Bilobed Flap for Reconstruction of Skin Defects after Excision of Parotid Carcinoma: A Case Report.

Local flaps, pedicled flaps, and free flaps are used to reconstruct medium-sized skin defects after excision of parotid carcinoma. The bilobed flap is a local flap primarily used by plastic surgeons for small defects of nasal skin. We report a case of parotid carcinoma with skin infiltration successfully treated by skin reconstruction with a bilobed flap. An 84-year-old man presented with a parotid mass he had noticed 2 months earlier. Parotid carcinoma with skin infiltration was diagnosed and he underwent radical surgery. The skin defect was round (diameter, 6 cm) and was resected and reconstructed with a bilobed flap designed to be caudal to the defect. Postoperative facial nerve palsy improved within 6 months. The postoperative course was otherwise uneventful, and the patient was discharged on postoperative day 7. Pathological examination revealed a sarcomatoid salivary duct carcinoma. Bilobed flaps are useful for reconstructing skin defects with a diameter of 6 cm or less.

Bilobed flaps for cutaneous nasal defects: a case series

The bilobed flap is a local flap used for the reconstruction of small to moderate cutaneous nasal defects. It was first described by Esser in 1918 for use in nasal tip reconstruction. It is a double transposition flap where the first flap serves to fill the primary defect, and a second smaller fills the secondary defect. This approach seeks to distribute tension across a wider area. It is a random pattern flap with no specified blood supply. This study was done at the department of plastic and reconstructive surgery, Saveetha medical college and hospital, from January 2018 to December 2018. Five patients (four female and one male) underwent bilobed flap to reconstruct the cutaneous nasal defects out of which three patients had naevus while two patients had basal cell carcinoma nose. Their ages ranged from 35-68 years with a mean age of 52 years. The procedures were done under local anaesthesia. Post-operatively, all sutures were removed on the 5th day. This technique was performed in 5 cases with defect size ranging from 0.9×1.1 to 1.3×1.8 cm. All defects were closed under minimal wound tension, all scars were inconspicuous, no obvious complications occurred, and the aesthetic outcomes were considered favorable. The bilobed flap is a versatile, easy to perform and reliable flap for closure of small nasal cutaneous defects with good aesthetic outcomes, reduced morbidity and less scarring.

Glabellar superciliary bilobed flap for reconstruction of large medial canthus region defect

The aim of this study was to describe a series of patients who have undergone a medial canthal reconstruction with a glabellar superciliary bilobed flap. A series of 30 patients were included with medial canthal defects after excision of medial canthal tumour who underwent reconstruction using a glabellar-superciliary bilobed flap of adjoining skin and subcutaneous tissue. Eighteen procedures were performed under local anaesthesia. The remaining 12 cases were combined with major lid reconstruction and performed under general anaesthesia. Complete closure of the defect, aesthetic outcome, complications, and re-operations were all used as outcome measures. Primary closure of the donor site was achieved in all cases without wound dehiscence. In all cases, the cosmetic appearance was highly satisfactory to the surgeons and patients and there were no intraoperative complications. The glabellar superciliary bilobed flap is an effective, quick, simple, and single-stage technique for medial canthal region reconstruction. It provides excellent cosmesis and is associated with minimal complications. It can be modified according to the nature of the periorbital skin, location, size, and depth of the defect.

Basal cell carcinoma excision with bilobed flap nasal reconstruction

: Basal cell carcinoma (BCC) is a slow growing, locally destructive, malignant tumor of the skin. It is derived from non- keratinizing cells that originate from the basal layer of the epidermis. After excision nasolabial flap, median forehead dorsal nasal flap, glabellar flaps, bilobed flaps, cheek and craniofacial flaps are used for nasal reconstruction. The Zitelli’s bilobed flap is one of the most useful flaps for nasal reconstruction. It is a simple double transposition flap and is designed to move more skin, without deformation. A 60-years old male patient reported to our department with complains of circular raised and reddish discoloration lesion on the left side of the nose. Surgical excision and reconstruction of defect using bilobed flap was planned under general anaesthesia. The flap was designed in such a manner that the flap could be turned over the defect on the ala of the nose and closure of the donor site could be done primarily without deformity. Surgical excision of the nose lesion was done and reconstruction was performed using bilobed flap. The patient has been followed up for 1year with no evidence of recurrence. The bilobed flap is a versatile and reliable flap for coverage of small skin and soft tissue defects of the lower third of the nose. It gives a successful outcome if it is designed well and performed properly. In this case it helped us to achieve a defect free cosmetically fine nose after excision of basal cell carcinoma nose.

One-sized bilobed flap does not fit all standing cones: a mathematical analysis of the standing cone in bilobed flap dynamics.

The bilobed flap (BLF) is a workhorse for nasal repair. Alterations to the length and orientation of the BLF's standing cutaneous deformity (SCD) have been suggested as a means of preventing Z-plasty-induced flap lengthening and consequent ipsilateral alar depression. To investigate the effect of design variations of the SCD on bilobed flap mechanics. Geometric analysis of the BLF was performed using commercially available graphing software. BLFs were designed with a SCD equal to one radius (rBLF) and one diameter (dBLF) of the primary defect as well as with a more superiorly-oriented one diameter SCD (soBLF). Lengths from the pivot point to the distal edges of the primary defect and primary lobe were measured and compared. Elongation or a more superior orientation of the SCD without changes to the rest of the flap design forms a primary lobe along a shorter arc resulting in insufficient flap length to resurface the primary defect. The insufficient length requires secondary motion to complete the repair and possible unintended alar displacement. Modification of the size and orientation of the SCD alters the location of the pivot point, which is a key determinant of BLF mechanics. Therefore, changes to the SCD require alterations to the remainder of the flap design to ensure aesthetic and functional success.

Facilitated harvesting of a radial artery superficial palmar branch flap for reconstruction of moderate finger skin defects

Radial artery superficial palmar branch harvesting is technically challenging, especially for inexperienced hand surgeons. The short pedicle and a damaged recipient digital artery require proximal digital artery dissection and relatively long pedicles. Herein, we describe a facilitated flap elevation technique and its application in various cases. From 2013 to 2021, 10 patients with finger injuries received radial artery superficial palmar flaps. We assessed flap survival, sizes, complications, two-point discrimination, and the Semmes-Weinstein monofilament test results. The main shortcoming of a radial artery superficial palmar flap is its short pedicle. Therefore, we developed a long skin flap design in the long axis direction, and the accompanying vein was dissected proximally to the radial artery to obtain a long pedicle. All flaps survived. The median flap dimension was 5.0×2.2cm (maximum size: 6.0×2.0+5.0×2.0cm [for a bilobed flap]). While nerve reconstruction was performed in one patient, all patients had preserved sensation. A sufficiently long pedicle can be obtained by dissecting the accompanying vein proximally to the radial artery. Perforators found in the skin around the scaphoid tubercle in all cases suggest value in including this region in flap design. To obtain a longer pedicle, the flap was developed with the long-skin design in the long-axis direction. Although the accompanying vein is usually thin and difficult to anastomose with the finger vein, its proximal dissection led to the accompanying vein of the radial artery that facilitated the harvesting of a sufficiently long vein.

Long-Term Follow-Up of Ulnar Growth in Radial Dysplasia Treated by a Combination of Distraction and Radialization

To study the long-term results of radial club hand, regarding ulna growth, radial angulation, and volar subluxation using a 2-stage treatment protocol. From 1998 to 2009, 39 radial club hands (32 patients) were treated with distraction, radialization, and a bilobed flap. Long-term follow-up was available in 13 patients (17 hands; average 12.6 years, range 9-16 years). All 17 hands were classified as Bayne and Klug grade3 or4. The average age at distraction was 12 months (SD 5.3). The average age at radialization was 14 months (SD 5.8). At final follow-up, the average ulna length on the involved side was 69.3% of the uninvolved contralateral side in the unilateral cases. In the 4 bilateral cases, the average ulna length was 62% of the ulna length of a cohort of normal children. The transverse diameter of the ulna in the posteroanterior view was 79%, and in the lateral view 99%, of the radius on the contralateral side in the unilateral cases. The average radial deviation improved from 82° to 8° and the average volar subluxation improved from 20° to 12°. However, in 4 hands recurrent volar subluxation and required revision surgery. This approach to treatment was associated with consistent results in the correction of the radial angulation, volar subluxation, and ulna growth in long-term follow-up. Volar subluxation may result in a requirement for revision. Therapeutic IV.

Reconstruction des pertes de substances du nez : algorithme décisionnel à propos de 229 cas

The Face is the most frequent localization for cutaneous carcinoma. The nose accounts for about 30% of these tumors. Nose tissue loss repair has to pursue 3 types of objectives: carcinologic, aesthetic and functional. The aim of this article is to identify a decision tree to guide the choice of surgical reconstruction technique based on localization and size of the defect. We performed a retrospective analysis in Angers' CHU from 2013 to 2019 including 229 patients referred for cutaneous tumors excision in need of reconstruction. We analyzed the type of reconstruction, size of the tissue loss and localization of the defect in terms of nose aesthetic subunits. Among the 229 patients included, the most frequent localization was nose tip (32%). 44% of patients were reconstructed with skin grafts or composite graft, 56% with flaps (48% local flaps and 4% association of both methods). Limited central resections of nose tip were reconstructed with skingraft. The Rybka flap and bilobed flap were the preferred choice for lateral reconstruction of nose tip. Largest tip defects were reconstructed using Rieger flap or forehead flap. The dorsum was often reconstructed with local flap: glabellar on the upper part, Rieger on the lower part. Lateral side was perfectly reconstructed with island flap. Nose wings needed framework: composite graft was the judicious choice in case of limited tissue loss whereas forehead flap with framework or Schmid-Meyer flap were chosen for larger defects. Our past experience in nasal reconstruction has provided us with an original decision tree to guide surgeons in choosing the right reconstruction technique according to the size and localization of the defect.

Nose Reconstruction Using Bilobed Flap: A Case Report

This document illustrates the formatting process for authors, who would be preparing their papers for publication in the International Journal of Scientific Advances (IJSCIA). It behooves the prospective authors the skillset, scientific or scholarly acumen and wherewithal to ensure that their manuscript contents are original and have never been submitted to other journals while under review in the IJSCIA. Background: Basal cell carcinoma (BCC) is a slow-growing, locally destructive malignant skin tumor. The nasal location is considered a high-risk feature of BCC because of its anatomical features and problems in identifying the tumor preoperatively. Surgery is the cornerstone of nasal BCC treatment and various techniques have been developed to combine full 3D tumor removal with good aesthetic and functional results. Case Presentation: We report a circular black discoloration of a 64-year-old male patient on the left side of the nose within 2 years. The patient was scheduled for surgical removal and reconstruction of the defect using a bilobed flap. The flap consists of two lobes with a common semicircular base marked around the transverse portion of the nasalis muscle and its aponeurosis. The flap then removes the skin from the triangular peninsula at the base of the defect. After removal, the flap is moved into the defect and placed with 5-0 Prolene with a simple suture. Conclusion: The bilobed flap has multipurpose in all ways. The main benefit of this flap include the similarity color and texture relative to the defect site, ease of reproducibility, low complication rates, and the ability to design it in different sizes and tissue compositions.

Eyelid Reconstruction: An Algorithm Based on Defect Location.

Eyelid reconstruction is a complex topic. This review looks at articles from 1990 to 2018 on eyelid reconstruction that had at least 10 patients and a mean 6 month follow-up. The authors present the results of our findings and propose an algorithm to guide the surgeon in choosing the best technique based on location, size, and lamella. Defects less than 1/3rd of the upper or lower eyelid may be closed primarily. Anterior and posterior lamella defects of the lower eyelid greater than 1/3rd in size should be reconstructed with a double mucosal and myocutaneous island flap. Those greater than 50% in size should be recreated with a Tripier flap for the anterior lamella and conchal chondroperichondral graft for the posterior lamella. For total lid reconstruction, a Fricke flap is best for the anterior lamella and the tarsoconjunctival free graft/lateral orbital rim periosteal flap is best for the posterior lamella. Fullthickness defects between 1/3rd and 2/3rd in size of the upper eyelid should be reconstructed with a myotarsocutaneous flap and those greater than 2/3rd should be reconstructed with a Cutler-Beard flap for the anterior lamella and auricular cartilage for the posterior lamella. For the medial canthal region, the island pedicle and horizontal cheek advancement flap is recommended for the anterior lamella and a composite upper lid graft for the posterior lamella. For the lateral canthal region, a bilobed flap is recommended for the anterior lamella and a periosteal flap for the posterior lamella.

Evaluation of Intraoperative Triamcinolone Injection or Primary Lobe Tacking (Pexing) Sutures for Preventing Pincushioning in Bilobed Transposition Flaps.

Bilobed transposition flaps are prone to pincushioning (trapdooring), whereby contraction of the flap over the wound bed may produce an unsatisfactory functional and aesthetic outcome. There are several proposed methods to prevent this, but there is currently no clear consensus on the ideal technique. To compare primary lobe pexing sutures versus intraoperative triamcinolone (TAC) injection as methods to prevent pincushioning in bilobed transposition flaps. A retrospective chart review of bilobed flap reconstructions identified from the Mohs micrographic surgery database at a single tertiary center in New Zealand. Three hundred forty-two patients met the inclusion criteria: 37 received pexing sutures, 42 intraoperative TAC, and 263 no additional intervention. The most defect common location was the nasal tip (43.6%), followed by the ala (20.8%). Ninety-three participants (27.2%) developed pincushioning at a median 35 days postoperatively. Participants receiving no intervention had a 30.8% pincushioning rate. The TAC group had a 23.8% pincushioning rate (p = .358), and the pexing group had a 5.5% pincushioning rate (p = .001). Participants receiving primary lobe pexing sutures had a statistically significantly lower rate of pincushioning than those receiving no intervention. Intraoperative TAC injections appeared to have little impact on pincushioning.

SMaRT Assessment Tool: An Innovative Approach for Objective Assessment of Flap Designs.

The teaching and assessment of ideal surgical markings for local flaps required for optimal aesthetic and functional outcomes remain a challenge in the present era of competency-based surgical education. The authors utilized the bilobed flap for nasal reconstruction as a proof of concept for the development of an innovative objective assessment tool based on statistical shape analysis, with a focus on providing automated, evidence-based, objective, specific, and practical feedback to the learner. The proposed tool is based on Procrustes statistical shape analysis, previously used for the assessment of facial asymmetry in plastic surgery. For performance boundary testing, a series of optimal and suboptimal designs generated in deliberate violation of the established ideals of optimal bilobed flap design were evaluated, and a four-component feedback score of Scale, Mismatch, Rotation, and Translation (SMaRT) was generated. The SMaRT assessment tool demonstrated the capacity to proportionally score a spectrum of designs (n = 36) ranging from subtle to significant variations of optimal, with excellent computational and clinically reasonable performance boundaries. In terms of shape mismatch, changes in SMaRT score also correlated with intended violations in designs away from the ideal flap design. This innovative educational approach could aid in incorporating objective feedback in simulation-based platforms in order to facilitate deliberate practice in flap design, with the potential for adoption in other fields of plastic surgery to automate assessment processes.

Bilobed flap reconstruction for skin defects after parotid carcinoma surgery.

To analyse the treatment results of bilobed flap reconstruction performed for skin defects after parotid carcinoma surgery. Ten patients who underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery in our hospital, from 2014 to 2020, were retrospectively enrolled. All patients underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery. The size of the skin defect was 2.7 × 2.2 cm in the smallest dimension and 9.0 × 6.3 cm in the largest dimension. All bilobed flaps except one healed without any problems. One patient developed partial flap necrosis in the retroauricular region, and was treated with skin grafts after removal of the necrotic tissue under local anaesthesia. All bilobed flaps, including the cases in which skin grafts were performed, survived after post-operative radiotherapy or chemotherapy. A bilobed flap is a good reconstruction option for skin defects after parotid carcinoma surgery in some cases.

Bilobed Flap in Hand Clinodactyly Reconstruction: Technique Description and Result Appraisal.

Objective Clinodactyly is a congenital hand deformity that is characterized by coronal angular deviation and may occur in thumbs or fingers. Surgical treatment is indicated for severe angulations. Among the described techniques, one of the options consists of bone alignment by wedge-shaped addition osteotomy of the anomalous phalanx. Such alignment maneuver creates a problem in skin cover, along with soft-tissue tension at the concave aspect of the deformity. Hence, some sort of skin flap is required for the adequate operative wound closure. We aim to demonstrate the aforementioned technique and to assess the results of bilobed flap in the treatment of hand clinodactyly. Methods Retrospective study conducted between January 2008 and January 2015. Five patients were included in the study, including nine operated digits. Surgical indication consisted of angular deviations ˃ 30 o . Neither patients with thumb deformities nor those with deformities associated to syndromes were excluded from the study. We assessed the functional and cosmetic outcomes of the technique, as well as complications and the satisfaction rates of the family. Results All patients had satisfactory functional and cosmetic results, with a mean skin healing of 18.6 days. Among nine operated digits, only one of the patients presented vascular compromise at the distal portion of the first flap lobe, albeit without necrosis or the need for any additional procedure. Patients were followed up on a minimum of 12-month interval. No deformity recurred during the observation period. Conclusion Bilobed flap for the treatment of hand clinodactyly is a good option for skin cover after the osteotomy.

Clinical effects of anterolateral thigh perforator flap with sensory nerves in repairing the plantar skin and soft tissue defects

Objective: To explore the clinical effects of anterolateral thigh perforator flap with sensory nerves in repairing the plantar skin and soft tissue defects. Methods: From January 2016 to March 2019, 13 male patients with plantar skin and soft tissue defects were admitted to the Department of Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, aged 27 to 73 years. The retrospective cohort study was conducted. The wounds of 4 patients underwent 2 times of debridement. The wounds of 9 patients underwent 1 time of debridement and 1 or 2 time(s) of vacuum sealing drainage. Then all the wounds of patients were repaired with flaps when the wounds were clean and dry with no purulent exudation and were negative in secretion culture. The wound areas of this group of patients after wound debridement were 13.0 cm×5.5 cm to 36.0 cm×10.5 cm, and the wounds were repaired with anterolateral thigh perforator flaps with sensory nerves with area of 14 cm×6 cm to 37 cm×11 cm. The wound of 1 patient was repaired with a bilobed flap. The oblique or descending branch of the lateral circumflex femoral artery and its accompanying vein in the flap were anastomosed with the posterior tibial artery and its accompanying vein or the medial plantar artery and its accompanying vein in recipient sites. The lateral femoral cutaneous nerve in the flap was anastomosed with the recipient saphenous nerve or medial plantar cutaneous nerve. The donor sites were directly sutured. The survival of flaps and the healing of wounds in the donor and recipient areas were recorded, and the ulcers of the plantar repaired flap were followed up for 3 months after operation. The sensory function of the flap was evaluated by the sensory evaluation standard of British Medical Research Council (BMRC), and the ankle and foot function score system of American Orthopedic Foot and Ankle Society (AOFAS) was used for comprehensive functional evaluation at the last follow-up. Results: All the 14 flaps in 13 cases survived, and venous crisis occurred in two cases and the flaps survived smoothly after the venous re-anastomosis. One patient developed deep tissue infection after being discharged and was healed after secondary debridement. The donor and recipient areas of the remaining patients healed well. The patients were followed up for 6 to 18 months, the shape of flaps was slightly bloated in 5 patients, and the shape and texture of flaps in the other 8 patients were good. Six patients had ulcers in flaps at 3 months of follow-up after operation, which were healed after stopping weight-bearing activities. At the last follow-up, little linear scar hyperplasia could be seen in the donor site of patients; the BMRC sensory function evaluation results were S1 grade in 4 cases, S2 grade in 7 cases, and S3 grade in 2 cases; the AOFAS scores were excellent in 3 cases, good in 7 cases, fair in 2 cases, and poor in 1 case. Conclusions: The anterolateral thigh perforator flaps with sensory nerves can repair the plantar skin and soft tissue defects with the donor sites directly sutured and good shape of flaps, which provide a good treatment method for the recovery of plantar proprioceptive sensation and weight-bearing function.

Postauricular Cutaneous Mastoid Fistula Closure with Combination of Bilobed Flap and Fibro-Muscular-Periosteal Flap

Chronic suppurative otitis media (CSOM) with cholesteatoma can present with intratemporal complications such as postauricular subperiosteal abscess with or without fistula. In some postauricular cutaneous mastoid fistula cases, direct closure of the wound is not possible due to skin tension, leading to skin necrosis and postoperative recurrent cutaneous fistula. Here, we describe a surgical technique using a combination of a bilobed flap and a fibro-muscular-periosteal flap for fistula closure on a 31-year-old and a 35-year-old female with postauricular cutaneous mastoid fistula due to CSOM. All patients were successfully managed with no fistula recurrence.

Geometric Analysis of the Bilobed Flap for Nasal Reconstruction Surgery

Background: Reconstruction of the nose can be difficult due to its complex anatomical features. In 1989, Zitelli described a modified version of the bilobed flap design technique using 45° and 90° angles to improve nasal reconstructions. While the bilobed flap is still frequently referenced in scholarly literature, there seems to be inconsistency in preoperative flap design; these deviations can lead to suboptimal outcomes. The authors aim to illustrate the variability in bilobed flap execution and provide guidelines in preoperative design to improve consistency. Methods: A geometrically-based approach was used to characterize the inconsistency of bilobed repair technique. The pre-operative design images from fifteen scholarly articles were analyzed via a series of measurements and computations to quantify the angle of rotation and dimensions for the primary and secondary lobes. The “Error Quotient” was a calculated ratio that objectively measured the extent to which a bilobed design deviated from Zitelli’s specifications. Results: There was a noticeable variability in the design of both the primary and secondary lobes. Bilobed designs with smaller angles of rotation, particularly of the first lobe, were associated with higher Error Quotients and greater amounts of deviation from Zitelli’s design. Designs with the smallest Error Quotients had a primary lobe rotation that approached 45°. Conclusion: Consistency of application of the bilobed flap should be established to allow for optimal results, particularly with emphasis on design of the primary lobe. This can be accomplished by including a disposable protractor and marker in their sterile kit to measure a 45° rotation.

A Systematic Review and Overview of Flap Reconstructive Techniques for Nasal Skin Defects.

Background: Reconstruction of nasal skin defects can be challenging due to limited skin laxity and underlying cartilage and, therefore, often require a complex repair. The aim of this review is to systematically analyze the literature on nasal skin reconstructions with specific detail to flap reconstructions. Methods: A systematic literature review of nasal skin reconstruction was performed and focused on flap reconstructions. Flap reconstructions were stratified based on defect size, nasal subunit, and reconstruction type. Complication rates (CRs) and patient outcomes were also assessed. Results: A total of 176 articles (11,370 patients) met the inclusion criteria. Of these, 59 articles showed various flap techniques. For defects ≤1.5 cm, every subunit had four to six options except the alar rim, which showed one option. Rotation-advancement flaps were mostly used for the nasal tip and sidewall, whereas bilobed flaps were used more for the ala and dorsum. Defects >1.5 cm were most commonly reconstructed with the forehead flap. The mean CR of flap reconstructions was 13.8%. Only 8 of the 176 articles (4.5%) reported patient satisfaction using a standardized questionnaire. Conclusion: This review shows various flap reconstruction options with their corresponding CR that will help guide the surgeon in choosing reconstructive options for different nasal skin defects.

A Meta-analysis of Complication Rates Among Various Surgical Modifications of Pectoralis Major Myocutaneous Flap.

The purpose of this study is to aggregate and summarize the complication rates among various modified techniques of pectoralis major myocutaneous flap harvesting. Various databases were searched from its inception to September 2020. Studies describing surgical management of head and neck oncologic reconstruction using pectoralis major myocutaneous flap and its surgical modifications were included in study. All included studies: (1) described a pectoralis major flap harvesting technique categorized by author as conventional technique, bipaddle or bilobed flap, segmental flap, flap transfer using subclavicular route, skin paddle over Pectoralis Major, Flap with Multiple vascular supply, U shaped skin paddle, modified short incision technique; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total 183 studies were included. Segmental flap (0.20%), flap with multiple vascular supply (5.18%) and parasternal skin flap (6.38%) had the highest rates of total complications and were the only techniques to show a statistically significant increase in odds ratio compared with conventional technique (odds ratio 1.89, 9.05 and 7.26, respectively, P < 0.05). Bipaddle flap (57.48%) and u shaped skin flap (78.05%) show statistically significant decrease in odds ratio as compared to conventional technique. Among all the modifications in surgical technique of pectoralis major myocutaneous flap harvesting bipaddle flap and u shaped skin flap show least total complication rates. But on the contrary rates of partial flap necrosis and fistula are significantly higher in bipaddle flap as compared to conventional technique. As such, the choice of surgical technique should primarily be made based on the defect size, patient selection and surgeons' discretion rather than the presumed complicationrate.

Nasalis-Based V to Y Flap Versus the Bilobed Flap.

Reconstructing defects on the nose can be challenging. The bilobed transposition flap and the nasalis-based V to Y (NBVY) flaps can be excellent repair options, each with their own advantages and disadvantages. To compare bilobed and NBVY flap scar appearances, postoperative complications, scar revision rates, flap sizes, and relative costs. We reviewed 95 cases of Mohs surgery defects on the nose repaired with either a bilobed or a NBVY flap from 2010 to 2018 at our institution. Eleven reviewers judged postoperative scar images using a modified visual analog scale. There were no significant differences in reviewer-rated scar appearances, complication rates, or revision rates between bilobed and NBVY flaps. The NBVY flaps were 50% smaller than bilobed flaps, with significantly lower CPT billing codes. The NBVY flaps yielded better scar appearance scores compared with bilobed flaps on highly sebaceous noses. The NBVY and bilobed flaps demonstrated similar scar appearance outcomes, but the NBVY flap has several advantages. Compared with the bilobed flap, the NBVY flap is smaller, less expensive, and may yield better cosmetic outcomes in patients with highly sebaceous noses.