Direct Primary Closure Research Articles

The Bilobed Flap in Nasal Repair

Surface defects resulting from excision of nasal lesions are commonly repaired by direct primary closure, skin grafts, or pedicle flaps. An effective but seldom used bilobed adjacent flap described by Esser and Zimany deserves increased attention in nasal reconstruction. This flap design possesses the following virtues: (1) Primary nondelayed transposition, (2) excellent color match, (3) primary closure of donor site, (4) one-stage repair, and (5) minimal tissue distortion. Zimany described the bilobed flap as one consisting of two lobes separated by more or less of an angle and based upon a common pedicle. The glabellar and nasolabial area serve as an abundant resource for tissue donation in nasal defect repair, without significant residual donor site deformity. The secondary donor site of the bilobed flap is effectively camouflaged in a natural skin fold or wrinkle, creating no significant facial deformity and providing a cosmetically superior repair.

Early repair of ventricular septal defect in infants and young children.

In infants and young children with ventricular septal defects (VSD) direct primary closure of the VSD can give very satisfactory results with a mortality that compares well with that of pulmonary artery banding. Twenty-four infants ranging in age from 5 to 29 months and in weight from 4.2 kg to 11.5 kg (9 to 25 lb) underwent intracardiac repair of their defect. Six had an associated atrial septal defect and two a patent ductus arteriosus. Of the four hospital deaths (none younger than 12 months of age), two patients had multiple muscular defects, and all four had a pulmonary artery pressure equal to the systemic with increased pulmonary vascular resistance (over 6 units). The surviving 20 patients showed improvement in their weight, clinical cardiopulmonary status, and electrocardiographic patterns. A curative repair should be considered in the infant with VSD, especially in the presence of associated atrial septal defect.