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The bilobed flap is a local transposition flap used primarily for the reconstruction of small to moderate-sized cutaneous nasal defects, although it can be applied to other areas of the body. It was first described in 1918 by Esser for use in nasal tip reconstruction. The original flap used a rotational arc of 180 degrees and based the second lobe superiorly, towards the glabellar region. In 1989, Zitelli went on to describe limiting the total rotational arc to between 90 and 110 degrees; this variant is the most common modification in use today. This overview of the bilobed flap will describe the relevant anatomy and the situations in which the bilobed flap is most effectively employed, and it will describe in detail how to plan and execute this versatile flap. Objectives: Describe the technique of bilobed flap transposition. Identify the indications for bilobed flap transposition. Review the potential complications of bilobed flap transposition. Explain interprofessional team strategies for improving care coordination and communication in order to advance the use of bilobed flaps for reconstruction of nasal defects and to improve outcomes. Access free multiple choice questions on this topic.

The bilobed flap is a local transposition flap used primarily for the reconstruction of small to moderate-sized cutaneous nasal defects, although it can be applied to other areas of the body. It was first described in 1918 by Esser for use in nasal tip reconstruction. The original flap used a rotational arc of 180 degrees and based the second lobe superiorly, towards the glabellar region. In 1953, Zimany demonstrated that the second and third lobes could be smaller than the first and that the flap could be utilized for reconstruction in more anatomical areas. In the 1980s, McGregor and Soutar introduced the concept that a reduced pivotal angle would result in smaller standing cutaneous deformities and decreased pincushioning. Zitelli went on to describe limiting the total rotational arc to between 90 and 110 degrees; this variant is the most common modification in use today. This overview of the bilobed flap will focus on the most recent modification. Herein, the relevant anatomy and the situations in which the bilobed flap is most effectively employed will be described, as well as how to plan and transfer this versatile flap.[1][2][3][4][3]

The potential complications specific to this procedure are swelling, scarring, flap necrosis, infection, and bleeding. Due to the crescentic shape of the flap, it is at risk of developing a pincushion deformity as a result of subdermal tissue contraction. When tension at flap inset is minimized, less pincushioning is seen. Decreasing the arc of rotation is one way to minimize tension at closure, as is wide undermining. Standing cutaneous deformities are also a risk, and again can be reduced with a smaller rotation arc. In the original bilobed flap, as described by Esser with a 180 degree rotation, standing cutaneous deformities were almost inevitable, but they are much less common when employing the Zitelli modification. If closing tension is too great, perfusion will suffer, particularly venous drainge, and flap loss may occur. Infection can also appear in any area of the wound, but is more liable to appear in areas of necrosis. Postoperative bleeding can result in hematoma formation under the flap, which may compromise blood flow and potentially result in loss of the flap.

Bilobed flap transposition is a commonly employed reconstructive modality used by plastic surgeons, facial plastic surgeons, otolaryngologists, oral surgeons, and dermatologists. While most cases do not requires a large team, nursing care both during and after the procedure is essential to improve healing outcomes. Wound care nurses and physicians who have patients with facial and extremity defects that need closure should consult with a surgeon experienced in cutaneous reconstruction. [level 5]