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Bilobed flap design in nasal reconstruction.


The use of a bilobed bilobed

having two lobes.
 flap is a practical means of repairing surface defects of the nose that are smaller than 1.5 cm in diameter. This repair is a one-stage reconstruction procedure that can be performed with local anesthesia, with or without intravenous sedation.

When used to reconstruct the nose, the flap is best designed in such a manner as to allow for the best alignment of the resultant scar lines at the borders of the nasal aesthetic subunits. By positioning the final scars at the junctions between aesthetic subunit borders, the surgeon can achieve maximal camouflage of the flap.

In the original description of this procedure by Esser, the flap was rotated 180[degrees]. (1) In 1989, Zitelli modified this original design and described an arc of rotation of 90 to 110[degrees]. (2)

These flaps tend to swell postoperatively as a result of the circumferential incisions necessitated by their design. Theoretically, the multisided incision placement causes a greater disruption in flap lymphatics and likely contributes to the persistent edema edema (ĭdē`mə), abnormal accumulation of fluid in the body tissues or in the body cavities causing swelling or distention of the affected parts. .

A youthful-appearing 52-year-old man came to the office with a 14-mm defect of the supranasal tip (figure 1). Intraoperatively, the flap was designed so that the first donor lobe was the same size as the defect. The second lobe donor site was in line with the aesthetic border of the nasal dorsum dorsum /dor·sum/ (dor´sum) pl. dor´sa   [L.]
1. the back.

2. the aspect of an anatomical structure or part corresponding in position to the back; posterior in the human.
 and the left nasal sidewall. The entire rotation of the flap was 100[degrees] (figure 2). The patient received four postoperative intracutaneous intracutaneous /in·tra·cu·ta·ne·ous/ (in?trah-ku-ta´ne-us) within the skin.

in·tra·cu·ta·ne·ous
adj.
Within the skin; intradermal.
 injections of triamcinolone triamcinolone /tri·am·cin·o·lone/ (tri?am-sin´o-lon) a synthetic glucocorticoid used in replacement therapy for adrenocortical insufficiency and as an antiinflammatory and immunosuppressant in a wide variety of disorders.  to help with resolution of flap edema. At 3 months, the cosmetic result was excellent (figure 3).

[FIGURE 1-3 OMITTED]

References

(1.) Esser JFS See journaled file system and Joliet file system. . Gestielte lokale Nasenplastik mit Zweizipfligem lappen Deckung des Sekundaren Detektes vom ersten Zipfel durch den Zweiten. Dtsch Z Chirurgie 1918;143:385.

(2.) Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol 1989;125:957-9.

From the Division of Otolaryngology-Head and Neck Surgery, University of Utah The University of Utah (also The U or the U of U or the UU), located in Salt Lake City, is the flagship public research university in the state of Utah, and one of 10 institutions that make up the Utah System of Higher Education.  School of Medicine, Salt Lake City.
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Article Details
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Title Annotation:Facial Plastic Surgery Clinic
Author:Mobley, Steven
Publication:Ear, Nose and Throat Journal
Date:Jan 1, 2004
Words:326
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