Bilobed flap design in nasal reconstruction.The use of a bilobed 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 circumferential /cir·cum·fer·en·tial/ (-fer-en´shal) pertaining to a circumference; encircling; peripheral. incisions necessitated by their design. Theoretically, the multisided incision placement causes a greater disruption in flap lymphatics and likely contributes to the persistent edema angioneurotic edema angioedema. cardiac edema a manifestation of congestive heart failure, due to increased venous and capillary pressures and often associated with renal sodium retention. cytotoxic edema cerebral edema caused by hypoxic injury to brain tissue and decreased functioning of the cellular sodium pump so that the cellular elements accumulate fluid. . 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 lobe (lob) 1. a more or less well-defined portion of an organ or gland. 2. one of the main divisions of a tooth crown.lo´bar caudate lobe a small lobe of the liver between the inferior vena cava and the left lobe. was the same size as the defect. The second lobe donor site was in line with the aesthetic border of the nasal dorsum 1. the back. 2. the aspect of an anatomical structure or part corresponding in position to the back; posterior in the human. dor·sum (dôr  s 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 (  n tr 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.tri·am·cin·o·lone (tr 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 JFS - Jane's Fighting Ships JFS - Japan Finance Corporation for Small Business JFS - Jet Fuel Starter JFS - Jewish Family Services JFS - Joint Feasibility Study JFS - Joint Fire Support JFS - Journal of Forensic Sciences JFS - Journaled File System JFS - Jungfreisinnige Schweiz (German: Young Swiss Liberals). 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 School of Medicine, Salt Lake City. |
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