Reconstruction of trunk defects with bilobed myocutaneous flap.

This study describes the use of the bilobed myocutaneous (MC) flap for reconstruction of trunk defect. The authors employ this flap because it offers a greater flexibility in the use of available tissue than many other local conventional flaps, is easy to design, safe to elevate, and causes minimal donor-site morbidity. The bilobed MC flaps are based on their main muscular pedicle. The standard bilobed flaps are generally based on a random pattern blood supply, which were restricted to rigid length-to-width ratios to ensure viability. They are usually indicated in the repair of small defects of the nose, and scalp. When we want to apply to reconstruct on the larger trunk defect, especially for the potential to cause life-threatening complications, the bilobed M-C flap might be considered for reconstruction to decrease the potential risk of the complications.     

RETRACTED ARTICLE: Additional and Different Application of the Bilobed Flap: Bilobed in Bilobed Flap for Reconstruction of the Lower–Upper Lid and Lateral Canthal Defects

BACKGROUND: The rich blood supply to the skin of the face provides the reconstructive surgeon much variability with local flap planning. However, in the design of local flaps, incisions should be placed where the tension of the suture lines will not distort landmarks such as the lip, the ala, and especially the eyelid. METHODS: A case is presented with a different and further application of the bilobed flap in reconstruction of upper-lower and lateral canthal region defects. RESULTS: With the described approach, the early postoperative and 18-month follow-up periods were seen as uneventful. CONCLUSION: With regard to these local flap options, although the bilobed flap is an extremely useful flap whose usefulness in coverage of facial defects has been well described, no report has described its usage for eyelids and the lateral canthal region of this bilobed (bilobed in bilobed) flap variation.     

Free adipofascial flap for scalp reconstruction: case report

The authors describe a case in which a large defect of the scalp was present after tumor excision. It was covered with a free adipofascial flap and a split-thickness skin graft, with satisfactory results. Numerous similar cases of scalp defects reconstructed with other free flaps have been described. But since donor-site morbidity is minimized with free adipofascial flaps, they should be used more often for reconstruction of scalp defects.     

斧状皮瓣在头面部皮肤缺损修复中的应用

目的:探讨头面部皮肤组织缺损手术治疗中应用斧状皮瓣进行转移修复的效果。方法:利用头面部皮肤缺损周围正常皮肤的弹性及皮肤纹理走向,于缺损周边设计斧状皮瓣,修复皮肤组织的缺损。结果:自2010年以来,共利用斧状皮瓣修复头面部皮肤缺损缺损53例,均完全成活,切口Ⅰ期愈合,效果满意。结论:该方法设计简便,效果可靠,皮瓣易成活,是修复头面部皮肤缺损的一种较理想方法。     

Total scalp reconstruction with bilateral anterolateral thigh flaps

Large scalp defects can require complicated options for reconstruction, often only achieved with free flaps. In some cases, even a single free flap may not suffice. We review the literature for options in the coverage of all reported large scalp defects, and report a unique case in which total scalp reconstruction was required. In this case, two anterolateral thigh (ALT) flaps were used to resurface a large scalp and defect, covering a total of 743 cm(2). The defect occurred after resection and radiotherapy for desmoplastic melanoma, with several failed skin grafts and local flaps and osteoradionecrosis involving both inner and outer tables of the skull. The reconstruction was achieved as a single-stage reconstruction and involved wide resection of cranium and overlying soft-tissues and reconstruction with calcium phosphate bone graft substitute, titanium mesh, and two large ALT flaps. The reconstruction was successfully achieved, with minor postoperative complications including tip necrosis of one of the flaps and wound breakdown at one of the donor sites. This is the first reported case of two large ALT flaps for scalp resurfacing and may be the largest reported scalp defect to be completely resurfaced by free flaps. The use of bilateral ALT flaps can be a viable option for the reconstruction of large and/or complicated scalp defects.     

股前外侧双叶穿支皮瓣修复手部创面

目的：探讨股前外侧双叶穿支皮瓣修复手部创面的方法和疗效。方法2011年1月-2012年10月对9例手部创面采用游离股前外侧双叶穿支皮瓣修复,其中手部两处创面7例,另2例为洞穿性缺损。急诊修复创面桥接血管重建患肢血供1例,延期修复创面8例。结果本组9例皮瓣全部成活,术后随访3～6个月,供区外观仅为线状瘢痕,功能无明显影响。2例手部洞穿性缺损修复后外观满意,功能欠佳;其余7例创面修复后皮瓣质地柔软,外观稍臃肿,功能满意。结论股前外侧双叶穿支皮瓣可一次修复手部两个创面或通过拼接修复一处较大创面,而供区常可以直接缝合,优点明显。     

Superficial Circumflex Iliac Artery Perforator Flap with Bilobed Design for the Donor Defect after Wrap‐Around Flap Transfer Reconstruction

ObjectiveThe repair of great toe donor site defect after wrap‐around flap transfer is still controversial. The bilobed superficial circumflex iliac artery perforator (SCIP) flap can improve the aesthetics of the great toe while maintaining its function. Thus, this study aimed to report our experience in the reconstruction of big toe donor site defects with the bilobed SCIP flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From May 2017 to May 2020, 13 patients with the great toe donor site defect after wrap‐around flap transfer were included in this study. The average age of the patients was 44 years (range, 23–60 years). All patients received free bilobed SCIP flaps to reconstruct the donor site defect of the great toe. Relevant clinical features were recorded preoperatively. The thickness and design of the SCIP flap and the harvesting layer of the flap were measured during the operation. The survival rate of flaps and skin grafts and the incidence of infection were recorded after operation. At follow‐up, donor site complications and postoperative outcomes were evaluated.ResultsIn all cases, the SCIP flap covering the donor site of the great toe survived. All patients were followed up for 24–40 months (mean, 30.5 months). The average thickness of the SCIP flap was 0.38cm. All SCIP flaps were harvested from the superficial fascial layer except for three obese patients. The thin SCIP flap had a bilobed design with no further defatting procedures. Postoperatively, the great toe‐nail flap donor site regained its original appearance without bloating or flap necrosis. There was a hidden linear scar in the groin donor site, which did not affect hip joint movement. All patients were satisfied with the aesthetics of the surgical site.ConclusionThe SCIP flap with bilobed design for repairing the donor defect of the great toe after wrap‐around flap transfer is a kind of surgical method with excellent contour, meeting the requirements of function and aesthetics.     

Rationale for reconstruction of large scalp defects using the anterolateral thigh flap: structural and aesthetic outcomes

The advent of free tissue transfer has provided multiple options that allow preservation and maintain both the structural and aesthetic status of the scalp. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Eleven free anterolateral thigh flaps were used to reconstruct soft-tissue defects of different regions of the scalp. Two of these flaps were used for the occipital region, six for temporal regions, two for the frontoparietal midline region, and the remaining flap for a defect of the forehead. The study consisted of 10 males and one female whose ages ranged from 18 to 82 years (mean age: 52.5 years). Six patients had primary or recurrent cancer, four had acute or subacute wounds resulting from trauma or craniotomy, and one had high-tension electrical burn injury. The size of the flaps ranged from 14 to 27 cm in length and from 6 to 18 cm in width. The overall flap success rate was 100%. In two cases, primary thinning of the flap was performed to reconstruct a tissue defect of the temporal region in one patient and a forehead defect in the other. In two patients, the fascial layer of the flap was used as a source for a vascularized fascial flap to cover defects of the dura mater. No secondary corrections, including debulking procedures or scar revision, were necessary. No infections or hematomas were observed. Six cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed directly. No donor-site morbidity was observed. The authors conclude that with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent flap option for most scalp defects.     

The Bilobed Flap for Reconstruction of Distal Nasal Defect in Asians

Background  The aim of this study was to overcome nasal alar retraction that occurs with the use of the standard Zitelli’s bilobed flap for reconstruction of a distal nasal defect. Zitelli’s bilobed flap offers the ability to aesthetically reconstruct difficult defects in the distal nasal area. However, the standard Zitelli bilobed flap may sometimes result in nasal alar retraction which is likely to the result of excessive tension upon closure of the primary lobe and primary defect. Methods  We modified the bilobed flap based on the design of the standard Zitelli bilobed flap. The modification of the bilobed flap was designed to have a primary lobe that was 10% longer than the length of the distal defect edge from the flap’s pivot point, and the width of the primary lobe was equal to the width of the defect. The length of the secondary lobe was 130% of the length of the distal defect edge to the flap’s pivot point, and the width of the secondary lobe was two-thirds the width of the primary lobe. To make a slight downward displacement of the ipsilateral alar margin, the primary lobe was transposed to fill the primary defects. Results  The results of the reconstruction were satisfactory: there was good nasal contour and appropriate symmetry of the nasal tip and no alar retraction. Conclusion  The modification of Zitelli’s bilobed flap to have a longer primary lobe, which slightly displaced downward the ipsilateral alar margin intraoperatively, can prevent nasal alar retraction in the reconstruction of distal nasal defects in Asians.     

双叶旋转皮瓣在修复头皮缺损中的应用

目的：探讨和评价应用双叶旋转皮瓣修复头皮缺损的临床效果。方法：手术于局麻下进行,距头皮皮损边缘0.2cm～0.5cm完整切除皮损后,在缺损区周边正常头皮设计双叶旋转皮瓣,修复创面。结果：本组20例,缺损区域面积最大5cm×2.7cm,最小2cm×1.5cm,术后伤口均Ⅰ期愈合,皮瓣颜色、质地与周围头皮基本一致,术后随访1～12个月,皮瓣区毛发生长状况与周围头皮一致,切口瘢痕不明显,无感觉异常。结论：应用双叶旋转皮瓣修复头皮缺损,皮瓣张力小、血运丰富、易于成活,且毛发生长正常,皮瓣与周边头皮衔接良好,达到整形美容效果,是解决中小面积头皮缺损修复的一种良好方法,值得推广应用。     

Aplasia cutis of the scalp: a report of two cases

Congenital absence of skin is rare; it usually presents in the midline over the vertex of the skull. There may be a lack of skin only, but a defect in the skull, with or without dura, may also be present. Two cases of congenital scalp defect have been treated. A male neonate was seen on the day of birth and the soft tissue defect was closed by a rotation flap. A female baby of 2 months was seen for recurrent episodes of severe wound infection and profuse bleeding. The infection could only be sufficiently treated after coverage of the soft tissue defect with a scalp flap. Scalp defects should be treated operatively in cases where spontaneous epithelization from the edges of the wound cannot be expected to be complete within a few weeks. Skin defects wider than 1 cm. should preferably be covered by scalp flaps. Bony defects should always be covered by skin flaps or grafts. Received: 30 December 1999 / Accepted: 2 February 2000     

指神经血管蒂推进皮瓣修复指端缺损

目的 介绍指掌侧血管神经蒂推进皮瓣修复指端缺损的方法和临床效果.方法 按Littler法,在指残端设计皮瓣,分离血管神经蒂,以增加皮瓣推进距离,用于重建长度在2.2cm范围内的指端创面.1998年以来,应用6例,指端创面长度1.5-2.2cm.结果 皮瓣全部成活,随访3-12月,外形,感觉满意.结论 指掌侧血管神经蒂推进皮瓣,手术简单,效果确切,可修复长度在2.2cm范围内的指端缺损.     

Bilobed flaps in nasal reconstruction

The bilobed flap is a local transposition flap useful for the repair of nasal defects commonly seen after Mohs surgery. The bilobed flap has benefits over other nasal transposition or advancement flaps because it distributes wound closure tension over a larger surface area through the use of 2 lobes. This property is especially helpful for defects of the caudal portion of the nose, where the skin is less elastic. This article discusses the bilobed flap for nasal reconstruction along with the appropriate selection, design, and placement of the flap and the potential complications.     

Simple flaps for reconstruction of pediatric scalp defects after electrical burn

Objective:To analyze the management of high-voltage electrical burn injury of the scalp in our hospital.Methods:This study involved 10 patients who suffered from high-voltage electrical burn injury of ...     

A simple and effective technique for reconstructive surgery of medium-sized scalp defects

From June to December 1999, eight patients aged from 16 to 30 years with scalp defects ranging from 9-11 cm in the tonsural region secondary to high-voltage electrical burns underwent scalp reconstruction via a technique based on the Orticochéa method, but which was less complicated in design, easier to carry out, and also more efficient. The entire scalp was prepared for surgery subgalea, but in no case was the dura mater exposed. Then four local flaps were taken, i.e., two temporal, one frontal, and one occipital flap. The width of each flap was the same size as the diameter of the scalp defect, and the base of each flap included the main regional blood vessels: A straight-forward advancement technique for the four flaps was not sufficient to completely cover such scalp defects, and a rotational approach was also introduced. In fact, the originality of the presently-described technique lies in the rotational approach, which is extremely efficient. It is carried out via three backcuts, beginning with the first temporal flap, then the second temporal flap, and if necessary the occipital flap; but never the frontal flap. These backcuts are performed in such a way that they are subsequently hidden by hair growth. In the present study, no skin graft was necessary, and no complications were reported. All the patients were satisfied with the results of surgery, both as regards the cosmetic aspect and regrowth of hair, and also as regards scalp sensitivity.     

A-T形皮瓣修复头皮缺损

目的：介绍头皮缺损修复的一种方法。方法：先将缺损修剪成梯形或等腰锐角三角形创面。沿底边向两侧做切口线,长度分别为底边边长的1～2倍;切口线末端各做一个顶与创面方向相反,边长为1～1．5cm的等腰三角形,以利于皮瓣向创面移动。在帽状腱膜层与颅骨骨膜之间形成皮瓣,向受区推进修复创面。结果：14例头皮缺损中,面积最小为3cm×3cm,最大为6cmc4cm,全部皮瓣存活良好,创面得以Ⅰ期修复。结论：A-T形皮瓣制作简单,因该皮瓣的剥离范围广泛,对于皮肤缺乏弹性和活动性的头部来讲,是修复该部位缺损的一种良好方法。     

Large bilobed flap in the repair of face and neck defects

While the bilobed flap is an extremely useful flap and its usefulness in coverage of the small facial defects has been well described, there is no report related to its usage as an alternative to regional flaps, tissue expansion technique and free tissue transfers in the face and neck reconstruction. This report presents our experience with nine patients who had skin defects of their face and neck areas reconstructed with large bilobed flaps from adjacent areas. The results of the repair were satisfactory with respect to colour match, texture and functional properties. The purpose of this paper is simply to emphasize that this old and well-known technique for small-sized defects can also be suitable for reconstruction of large defects in the face and neck in selected cases.     

Extranasal Applications of the Bilobed Flap

Background. The bilobed flap has proven its utility in the reconstruction of distal nasal defects. The mechanics and geometry of the bilobed flap must be clearly understood to achieve these reproducible results. The novelty of the bilobed flap as it is applied to extranasal reconstruction is that the surgeon has some degree of variance in designing the size of the individual lobules of the flap, with a lower risk of secondary tissue distortion. Several variations of the bilobed flap are described, with emphasis on technique and the unique issues involved in its extranasal application.
Objective. Our experience with the multiple extranasal applications of the bilobed flap is described to demonstrate the usefulness of this reconstructive technique.
Methods. The general technique of the bilobed flap is described, with emphasis on the extranasal variations. Five anatomic locations are presented, with unique considerations and photographs.
Results. The bilobed flap as it is applied to extranasal reconstruction allows the surgeon some degree of variance in designing the size of the individual lobules of the flap (compared with the distal nose), with a lower risk of secondary tissue distortion. The flap must be carefully designed to place the incision lines as close to relaxed skin tension lines as possible. A meticulous suture technique is important in camouflaging the complex suture line of this flap, which in no circumstance completely parallels the relaxed skin tension lines.
Conclusion. We hope to expand the use of this versatile flap to extranasal locations. It can produce the equivalent excellent functional and esthetic results compared with its more common nasal application.