Case 7 Bilobed Flap

The bilobed flap is a random flap but is excellent for coverage of various surgical defects throughout the

Flaps Medical

Figure 4-10. A, The patient had undergone excisional biopsy of a malignant melanoma of the cheek elsewhere. The scar of previous excision was widely encompassed in the surgical incisions which were planned to provide access for a superficial parotidectomy. B An inferiorly based cervical Limberg flap has been elevated and the surgical bed of resection shows the branches of the facial nerve preserved. C, Postoperative appearance of the patient approximately 6 months following surgery.

Figure 4-10. A, The patient had undergone excisional biopsy of a malignant melanoma of the cheek elsewhere. The scar of previous excision was widely encompassed in the surgical incisions which were planned to provide access for a superficial parotidectomy. B An inferiorly based cervical Limberg flap has been elevated and the surgical bed of resection shows the branches of the facial nerve preserved. C, Postoperative appearance of the patient approximately 6 months following surgery.

body. The principle of "borrowing from Peter to pay Paul" is exemplified in the design and elevation of this flap.

The bilobed flap can be used very effectively on defects of the anterior cheek. Surgical defects of the skin and soft tissues of the cheek overlying the zygoma and the buccinator muscle are very well suited for reconstruction using a bilobed flap. The patient shown here has a recurrent malignant melanoma involving the skin and subcutaneous tissues of the left zygomatic region. The area of skin at risk around the tumor which measures approximately 5 cm in diameter is outlined, and the inferiorly based bilobed flap has been planned (Figure 4—11A).

The surgical excision is completed and Figure 4—11B shows the defect, exposing the branches of the facial nerve in the upper part of the surgical field. The bilobed flap is elevated, superficial to the facial musculature but keeping all the subcutaneous fat on the flap. The flap is rotated into the defect and final skin closure is shown in Figure 4—11C.

The postoperative appearance of the patient approximately 2 months following surgery shows satisfactory closure of the surgical defect with an acceptable esthetic result (Figure 4—11D). Bilobed flaps used in this fashion provide a very readily available tool for the closure of sizable skin defects of the cheek. The flap works best in patients who have excess or

Necrotic Wound

Figure 4-11. A, The lesion is a malignant melanoma in the left zygomatic region. A generous area of excision is outlined around the tumor and the inferiorly based bilobed flap is planned. B The primary lesion has been excised in continuity with the superficial parotid lobe and the contents of the upper neck. The branches of the facial nerve have been carefully preserved and are clearly demonstrated in the surgical bed. The bilobed flap has been elevated and retracted laterally. C, The bilobed flap is rotated into the surgical defect and sutured into place. D, Approximately 2 months later the flap has healed well and has produced an acceptable cosmetic result.

Figure 4-11. A, The lesion is a malignant melanoma in the left zygomatic region. A generous area of excision is outlined around the tumor and the inferiorly based bilobed flap is planned. B The primary lesion has been excised in continuity with the superficial parotid lobe and the contents of the upper neck. The branches of the facial nerve have been carefully preserved and are clearly demonstrated in the surgical bed. The bilobed flap has been elevated and retracted laterally. C, The bilobed flap is rotated into the surgical defect and sutured into place. D, Approximately 2 months later the flap has healed well and has produced an acceptable cosmetic result.

lax skin providing easy rotation of the flap and closure of the donor site deformity, leaving a transverse scar along the upper skin crease in the neck.

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