Abstract
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.
Similar content being viewed by others
Abbreviations
- BLF:
-
Bilobed flap
- SCD:
-
Standing cutaneous deformity
- rBLF:
-
A bilobed flap designed on the basis of an arc of rotation determined by a SCD of length equal to one radius of the primary defect
- dBLF:
-
A bilobed flap designed on the basis of an arc of rotation determined by a SCD of length equal to one diameter of the primary defect
- soBLF:
-
A bilobed flap designed on the basis of an arc of rotation determined by a superiorly-oriented SCD of length equal to one diameter of the primary defect
References
Esser JFS (1918) Gestelte local Nasenplastic mit Zwwiezipfligem lappen Deckung des Sekundaren Detektes vom ersten Zipfel durch den Zweiten. Dtsch Z Chirurgie 145:385
Zitelli JA (1989) The bilobed flap for nasal reconstruction. Arch Dermatol 125:957–959
Local flaps in facial reconstruction. St. Louis?]: St. Louis? : Mosby Elsevier; 2007.
Steiger JD (2011) Bilobed flaps in nasal reconstruction. Facial Plast Surg Clin North Am 19:107–111
Mobley S (2004) Bilobed flap design in nasal reconstruction. Ear Nose Throat J 83:26–27
Cook JL (2000) A review of the bilobed flap’s design with particular emphasis on the minimization of alar displacement. Dermatol Surg 26:354–362
Cook J (2005) Reconstructive utility of the bilobed flap: lessons from flap successes and failures. Dermatol Surg 31:1024–1033
Kirkland EB, Zitelli JA (2013) The bilobed flap versus the AIRNS flap for repair of distal nose defects. J Am Acad Dermatol 68:684–685
Dzubow LM (1987) The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol 13:1348–1353
Cho M, Kim D (2006) Modification of the Zitelli bilobed flap: a comparison of flap dynamics in human cadavers. Arch Facial Plast Surg 8:404–409
Xue C-Y, Li L, Guo L-L, Li J-H, Xing X (2009) The bilobed flap for reconstruction of distal nasal defect in Asians. Aesthetic Plast Surg 33:600–604
Zitelli JA (2006) Comments on a modified bilobed flap. Arch Facial Plast Surgery 8:410
Collins S, Dufresne R, Jellinek N (2008) The bilobed transposition flap for single-staged repair of large surgical defects involving the nasal ala. Dermatol Surg 34:1379–1385
Chu EA, Byrne PJ (2009) Local flaps I: bilobed, rhombic, and cervicofacial. Facial Plast Surg Clin North Am 17:349–360
Albertini JG, Hansen JP (2010) Trilobed flap reconstruction for distal nasal skin defects. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al] 36:1726–1735
Zoumalan R, Hazan C, Levine V, Shah A (2008) 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 10:181–185
Zitelli J (2008) Design aspect of the bilobed flap. Arch Facial Plast Surgery 10:186
Hove CR, Williams EF, Rodgers BJ (2001) Z-plasty: a concise review. Facial Plast Surg 17:289–294
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
A preliminary version of this manuscript was presented as a poster at the 2013 ASDS Annual Meeting.
Rights and permissions
About this article
Cite this article
Pelster, M.W., Maher, I.A. One-sized bilobed flap does not fit all standing cones: a mathematical analysis of the standing cone in bilobed flap dynamics. Arch Dermatol Res 315, 401–407 (2023). https://doi.org/10.1007/s00403-022-02361-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-022-02361-z