Bilobed Flap

An interesting flap design is the "bilobed flap" described by Esser (1918). The two flaps have a common base and form an angle between 45° and 180°. Smaller angles make it easier to rotate the two attached transposition flaps (Fig. 3.23), while larger angles require longer flaps and cause greater skin bunching.

These flaps are used in areas where the surrounding skin is not mobile enough to close the secondary defect, such as the nasal flank, the junction of the scalp and neck, the cheek, and the nasal tip area (Zimany 1953; Elliot 1969; Weerda 1978b, c, 1980c, d) (see Figs. 5.6, 5.8, 5.13, 5.28, 5.46, 8.19, 9.5, and 10.28).

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Fig. 3.23 a, c Modifications of the bilobed flap.

Fig. 3.23 a, c Modifications of the bilobed flap.

Bilobed Flap Alar Defect

Fig. 3.24 Rhomboid flap of Limberg (1967).

a The first flap incision is an extension of the axis B-D, and the second incision (E-F) is made parallel to G-A. b The flap is mobilized and the defect is closed. c Appearance after closure of all defects.

Fig. 3.24 Rhomboid flap of Limberg (1967).

a The first flap incision is an extension of the axis B-D, and the second incision (E-F) is made parallel to G-A. b The flap is mobilized and the defect is closed. c Appearance after closure of all defects.

Bilobed Flap

Fig. 3.25a Two opposing Limberg flaps are mobilized (arrows), and all the defects are closed (b).

Limberg Flap

Fig. 3.26 Rhomboid flap of

Dufourmentel (1962). a Pattern of the flap incision. b Mobilization and flap transfer. c Closure of all defects.

Fig. 3.26 Rhomboid flap of

Dufourmentel (1962). a Pattern of the flap incision. b Mobilization and flap transfer. c Closure of all defects.

Facial Plastic Surgery Flap DyingRhomboid Flap

Fig. 3.27a-c Defect covered with two modified rhomboid flaps corresponding to a Z-plasty.

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