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Indian J Surg Oncol 2021 Mar 8;12(1):39-47. Epub 2020 Oct 8.

Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India.

The gold standard reconstructive options for full-thickness defect of the oral cavity after resection of malignant lesions are the free flaps. But in developing nations due to resource constraints, it cannot be offered to all. Hence, pectoralis major myocutaneous (PMMC) flap as bilobed flaps is most commonly used. Read More

Facial Plast Surg Aesthet Med 2021 Mar 1. Epub 2021 Mar 1.

Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

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. A systematic literature review of nasal skin reconstruction was performed and focused on flap reconstructions. Read More

Dermatol Surg 2021 May;47(5):618-622

All authors are affiliated with the Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Background: 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.

Objective: To compare bilobed and NBVY flap scar appearances, postoperative complications, scar revision rates, flap sizes, and relative costs. Read More

Zhonghua Shao Shang Za Zhi 2020 Dec;36(12):1199-1203

Department of Plastic and Reconstructive Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100039, China.

To explore the methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and the management of secondary wound in donor site. From June 2015 to June 2019, 30 patients with soft tissue defect caused by various reasons or hyperplastic scar were hospitalized in the First Medical Center of Chinese PLA General Hospital, including 10 males and 20 females, aged 25-64 years, with 18 cases of head soft tissue defects caused by the growth and rupture of tumor, 7 cases of hypertrophic scar in trunk and limbs, and 5 cases of facial and neck soft tissue defects caused by trauma. The area of primary wound after debridement or enlarged lesion resection was 14 cm×10 cm-18 cm×16 cm. Read More

Acta Dermatovenerol Alp Pannonica Adriat 2020 Dec;29(4):209-214

Department of Dermatology and Allergology, Skin Cancer Center, Dresden Municipal Clinic, Dresden, Germany.

Introduction: Malignant keratinocyte tumors-that is, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-are commonly found on sun-exposed body areas such as the nose. The primary aim of tumor surgery is complete excision. Due to anatomical, functional, and aesthetic issues, reconstruction of such defects remains a challenge. Read More

Burns Trauma 2020 12;8:tkaa012. Epub 2020 Dec 12.

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai 200011, China.

Background: Sacral pressure ulcers are associated with high morbidity and, in some cases, result in mortality from severe sepsis. Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers. An ideal flap should be simple to design, have a reliable vascular supply and minimal donor site morbidity. Read More

J Plast Reconstr Aesthet Surg 2021 Apr 24;74(4):740-746. Epub 2020 Oct 24.

Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.

The incidence of skin cancer, which often affects the facial skin, has risen worldwide. After resecting such facial lesions, plastic reconstruction is necessary in most cases. The paramedian forehead flap (PFF) and the bilobed flap (BF) are commonly used for nasal reconstruction, but whether patients and physicians are satisfied with the esthetics is undetermined? In this study, scar questionnaires (Manchester Scar Scale, Vancouver Scar Scale, and Patient and Observer Scar Assessment Scale) and optical three-dimensional (3D) imaging were used for subjective and objective evaluation of esthetical outcomes after plastic reconstruction of the nose in 30 patients. Read More

Plast Reconstr Surg Glob Open 2020 Aug 11;8(8):e3040. Epub 2020 Aug 11.

Division of Plastic & Reconstructive Surgery, University of Miami, Miami, Fla.

The nasal tip is a complex zone for reconstruction. Numerous flap reconstructions have been proposed. In addition to the technique presented here, only the Gillies-Millard bishop's miter flap and the paramedian forehead flap should be considered. Read More

Dermatol Surg 2021 01;47(1):30-33

Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.

Background: In transposition flaps, thicker tissue and higher degrees of rotation are associated with increased pivotal restraint; however, limited experimental data exist quantifying the degree to which these affect flap biomechanics. The use of artificial skin models in conjunction with digital image correlation technology allows for investigation into biomechanical properties of skin flaps.

Objective: To quantify the effects of tissue thickness and rotational angles on pivotal restraint within transposition flaps using artificial skin models. Read More

J Orthop Surg Res 2020 Jun 11;15(1):216. Epub 2020 Jun 11.

Department of Gynecology, Xuzhou Maternal & Child Health Care Hospital, Xuzhou, 221009, Jiangsu, China.

Objectives: This paper describes imaging and anatomical features, in order to assess the feasibility of superficial circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients.

Methods: A total of 7 pediatric patients who were being treated with free single-pedicle bilobed SCIP flap reconstruction for multi-digit defects were included in this study. The details of the clinical features were collected, and the following were successively analyzed: the preoperative computed tomographic angiography (CTA) and color Doppler sonography (CDS) examinations for flap design, the intraoperative anatomy for perforator vessel, defect reconstruction and interphalangeal range of motion (ROM) and tactile sense, pain sense, and two-point discrimination recovery results. Read More

Int J Low Extrem Wounds 2020 Jun 11:1534734620923457. Epub 2020 Jun 11.

Chungnam National University, Daejeon, South Korea.

. Many different operative options have been used to cover sacral defects. Perforator flap enables wide defect reconstruction with long pedicle and a large arc of rotation while preserving gluteus maximus muscle, but the risk of vessel injury can jeopardize flap survival. Read More

Acta Chir Plast 2020 ;61(1-4):10-15

Introduction: The bilobed flap was first described by Esser in 1918. He used it to reconstruct the defects of the nose. It has been used in the reconstructions of trunk and feet defects by many authors since then. Read More

Ear Nose Throat J 2020 Apr 17:145561320918986. Epub 2020 Apr 17.

Faculty of Health Sciences, Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland.

The aim of this article was to feature the use of giant bilobed flaps in surgical reconstruction after total or subtotal petrosectomy in oncology cases. The Esser technique was renewed and adopted for coverage huge skin loss. The authors reported 4 cases illustrated pre- and postoperative photography and intraoperative planning and schema. Read More

Indian J Otolaryngol Head Neck Surg 2020 Mar 19;72(1):44-48. Epub 2019 Aug 19.

2Department of ENT, Military Hospital Pathankot, Punjab, India.

Reconstruction of full thickness defects after resection of oral cancer is a challenge. Although microvascular free flaps are considered the first choice, their use is limited in the developing regions by availability of resources and the expertise. In this study, we have presented our experience with the use of bipaddle pectoralis major myocutaneous (PMMC) flap as a single stage reconstruction option for defects of the oral cavity. Read More

Arch Dermatol Res 2020 Oct 14;312(8):575-579. Epub 2020 Feb 14.

Department of Dermatology, University of Minnesota, 516 Delaware St. SE, Mail Code 98, Philips-Wangensteen Building, Suite 4-420, Minneapolis, MN, 55455, USA.

Few studies exist that compare local flap repair designs either mathematically or clinically. Previous mathematical studies use a two-dimensional modeling approach, which is not suited to complex structures like the nose. To quantitatively analyze and compare flap designs for nasal repair using three-dimensional, photographic models. Read More

Atlas Oral Maxillofac Surg Clin North Am 2020 Mar;28(1):49-52

OHSU Oral & Maxillofacial Surgery Clinic, Mark O. Hatfield Research Center, 3250 SW Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address:

Dermatol Surg 2020 10;46(10):1279-1285

Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio.

Background: Bilobed transposition flaps are versatile random pattern flaps used in nasal and extranasal reconstruction as they preserve free margins, access distal tissue reservoirs, and reliably repair dynamic defects.

Objective: We highlight the utility of extranasal bilobed flaps to encourage surgeons to consider these flaps for Mohs micrographic surgery defects.

Methods: A two-institution retrospective chart review of patients reconstructed using an extranasal bilobed flap after Mohs micrographic surgery was performed. Read More

Arch Craniofac Surg 2019 Dec 20;20(6):382-387. Epub 2019 Dec 20.

Department of Plastic and Reconstructive Surgery, Gyeongsang National University Hospital, Jinju, Korea.

Background: Defects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Read More

J Craniofac Surg 2020 Mar/Apr;31(2):e169-e171

Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.

Skin cancer of the nose remains a common challenge for the reconstructive surgeon with full-thickness defects being particularly problematic. Reconstruction of the internal nasal lining poses the greatest difficulty with local tissue often having unsatisfactory vascularity or surface area. We describe the reconstruction of a full thickness nasal alar defect in a patient after failed full-thickness skin graft using a single stage procedure combining a bilobed flap with a turnover flap. Read More

Eplasty 2019 10;19:e23. Epub 2019 Dec 10.

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY.

Lateral breast defects of various causes can be reconstructed with random patterned local flaps utilizing oncoplastic techniques. These local flaps are used frequently in other areas but are infrequent in breast reconstruction despite affording excellent utility in small lateral defects. We sought to demonstrate this with a case series involving 5 patients who underwent oncoplastic breast surgery with random patterned flap reconstruction. Read More

Ophthalmic Plast Reconstr Surg 2020 Jul/Aug;36(4):372-374

From the Department of Ophthalmology, Uludag University, Bursa.

Purpose: To describe the reconstruction of large upper eyelid defects with bilobed flap and tarsoconjunctival graft.

Methods: The medical records of 5 patients who underwent upper eyelid tumor excision and eyelid reconstruction with a bilobed flap were reviewed. Various parameters, including demographic and clinical data, defect diameter, primary defect closure, complications, and follow-up time, were recorded. Read More

Plast Reconstr Surg 2020 01;145(1):231-234

From the Department of Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida.

Perineal reconstruction historically has been guided by the vertical rectus abdominis myocutaneous flap. In oncologic patients, because of prior surgical intervention, this donor site is often unavailable, the pelvis has been irradiated, and defects can be deep or irregularly contoured. Using plastic surgery principles of perforators, geometrically defined local tissue rearrangement, and flap inset, the authors have developed a modification of the gracilis flap to include a second soft-tissue arm similar to a bilobed flap. Read More

Facial Plast Surg Clin North Am 2019 Nov;27(4):571-579

The Center for Dermatology Care, 267 West Hillcrest Drive, Thousand Oaks, CA 91360, USA; Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.

To avoid complications or bad results following reconstruction of skin cancer defects, there are several factors that can be incorporated into the design and execution of repairs. These techniques not only decrease the need to correct bad results, they improve the final aesthetic and functional outcome. So although one surgeon might focus on standard corrective treatments, another might use elements of flap design and implementation that will decrease the need for such corrective procedures. Read More

Laryngorhinootologie 2019 Sep 9;98(9):608-611. Epub 2019 Sep 9.

Klinik und Poliklinik für Dermatologie und Allergologie, Hauttumorzentrum, Abteilung für Dermatochirurgie, Technische Universität München.

Classic transposition flaps (TF) consist of a single random pattern lobe, which is elevated (rotated) over an area of normal skin to reach the primary defect. Frequently mentioned modifications are the rhombic flaps according to Limberg and Dufourmentel as well as the unilateral multi lobed ("bilobed" and "trilobed") flaps 1, 2, 3, 4, 5, 6. The contralateral double TF presented here is a modification rarely mentioned in the literature 4. Read More

Zhonghua Shao Shang Za Zhi 2019 Aug;35(8):604-607

Department of Hand Surgery, Wuxi Hand Surgery Hospital, Wuxi 214062, China.

To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3. Read More

Zhonghua Shao Shang Za Zhi 2019 Jul;35(7):495-500

Department of Hand Surgery, Ruihua affiliated Hospital of Soochow University, Suzhou 215104, China.

To investigate the clinical effects of extra-long lateral femoral supercharged perforator flaps in repair of ankle and foot wounds. From March 2014 to October 2018, 16 patients with foot and ankle injuries were admitted to our hospital and left large area of wounds on foot and ankle after emergency treatment. There were 13 males and 3 females, with age of 27 to 60 years. Read More

Ann Plast Surg 2019 09;83(3):300-304

From the Long Island Plastic Surgical Group, Garden City.

Introduction: Nasal reconstruction after oncologic resection often constitutes a technically demanding task. The aim of this study was to investigate our experience with nasal reconstruction after Mohs micrographic surgery using the following 3 well-established, versatile, and reliable techniques: the bilobed flap, nasolabial flap, and forehead flap.

Methods: A single-surgeon retrospective chart review of all patients undergone a bilobed, nasolabial, or forehead flap for nasal reconstruction after Mohs micrographic surgery from 2003 to 2017 was conducted. Read More

J Dermatolog Treat 2021 Feb 25;32(1):84-89. Epub 2019 Jun 25.

Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Nasal tip reconstruction (NTR) of the Mohs defect is challenging, especially in Asians who have a relatively low nasal bridge and thin cartilages. To evaluate the usefulness of a new flap design, the checkmark rotation flap (CRF), for NTR in Asians We retrospectively reviewed 31 cases of NTR. Among these, 15 cases underwent CRF, which uses skin from the columellar or infra-tip area with a checkmark v-shaped incision (CRF group). Read More

Head Neck 2019 09 11;41(9):3282-3289. Epub 2019 Jun 11.

Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

Background: The donor site defect remains the major disadvantage of the radial forearm free flap (RFFF). The purpose of this case series was to evaluate the effectiveness and safety of a local bilobed flap in direct closure of the RFFF donor site defect.

Methods: Between February 2017 and July 2017, a prospective study was designed with 13 patients who had undergone RFFF reconstruction of the oral cavity. Read More

J Laryngol Otol 2019 08 6;133(8):723-726. Epub 2019 Jun 6.

Department of Neurosciences, Otolaryngology Section, University of Padova, Italy.

Background: A post-auricular cutaneous mastoid fistula is a rare condition that can occur following radical mastoid surgery, chronic suppurative otitis media or spontaneous exteriorisation of cholesteatoma from the mastoid through the post-auricular skin surface. Management of a post-auricular cutaneous mastoid fistula can be challenging for the surgeon.

Objective: This paper describes a surgical refinement for post-auricular cutaneous mastoid fistula closure, involving a fibro-muscular-periosteal flap to cover the mastoid cavity, combined with a bilobed flap from the mastoid and lateral neck regions for skin closure. Read More