Occasionally a bilobed flap is insufficient for repairing a cheek defect, which requires one lobe between the ear and defect (Fig. 8.10a), a second lobe behind the ear, and a third lobe in the lateral neck. As in an Esser cheek rotation, the lower limb of the third lobe may be extended below the mandible. Closure of the secondary defects may require the excision of Burow's triangles (Fig. 8.10b).
Fig. 8.10 Trilobed flap of Weerda (1979). a Trilobed flap for a defect in the temporal region consists of a preauricular lobe (1), a retroauricular lobe (2), and a neck lobe (3).
b The completed repair. All defects can be closed by excising Burow's triangles and mobilizing the surrounding skin.
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