Bilobed Flaps in Nasal Reconstruction (2023)

FAQs

What is the Bilobed flap for nasal reconstruction? ›

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.

Definition of Bilobed Flap

The key principles to this repair are^5,6,7: First lobe fills the primary defect, second lobe fills the secondary defect. Double transposition will distribute tension to wider area of skin. No specific blood supply (random pattern).

Closure of the bilobed flap can occur with suturing of the primary lobe to the first frenulum and suturing the secondary lobe to the second frenulum with circumferential sutures in the periphery of each lobe. One would suture these lobes with 4.0 nylon in a simple interrupted suture mattress.

The flap remains attached until the nose is fully healed. This is usually around 4 weeks. Once the nose has healed, the flap will be separated from the forehead.

The bilobed flap is a random transposition flap because its blood supply does not arise from a segmental artery and no defined pedicle is present. Blood is supplied to the skin via musculocutaneous and cutaneous arteries that perforate subcutaneous tissue.

The male reproductive part of the flowering plant has stamens. These stamens are filamentous structures that support the anther that produces the pollen grains. These anthers have two lobes and are termed bilobed anthers. The transverse section of the anther helps to distinguish this bilobed structure.

A flap is transferred with its blood supply intact, and a graft is a transfer of tissue without its own blood supply. Therefore, survival of the graft depends entirely on the blood supply from the recipient site. Flap surgery is a subspecialty of plastic and reconstructive surgery.

One major objective of flap surgery is to eliminate or reduce the pocket itself. To access it, a flap-like incision is made in the gum tissue.

A well-designed flap should use the minimal amount of tissue required, cause the least amount of donor site morbidity, and maximize the return of form and function to the tissue defect, while simultaneously optimizing the survivability of the flap to obviate the need for revision surgery in the future.

Blood vessels supplying the flap may kink or get clots, leading to bleeding and a loss of circulation. This may cause the tissue to die, leading to a partial or complete loss of the flap. This is more common in women who smoke or have recently quit. Quitting before surgery will help you to decrease the risk.

What is flap healing complication? ›

Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels.

You should notice a difference in the appearance of your nose about a week after rhinoplasty surgery when your splint comes off. It can take up to a year for your nose to fully settle into its new shape.

Every patient is different, so recovery times vary, but generally speaking, most patients can expect to look “normal” after about three to four weeks, with a small amount of residual swelling and tenderness lasting about three months — though it is usually only noticeable to the patient themselves.

Cartilage, which covers and cushions the surface of joints, generally does not regenerate once damaged, but "cartilage cells from the nasal septum (the part of the nose that separates the nostrils) are known to have a great capacity to grow and form new cartilage."

Valves are actually flaps (leaflets) that act as one-way inlets for blood coming into a ventricle and one-way outlets for blood leaving a ventricle.

Nasolabial Flaps are frequently used to repair defects of the nostril and nasal tip. In this procedure, skin is transplanted from the cheek to the nose in two outpatient procedures. Cheek skin has a similar color and texture to nasal skin, and the donor site scar can be hidden in a naturally occurring cheek fold.

Multiple classifications have been described, but, in general, flaps for reconstruction are classified based upon the type of blood supply (ie, random, axial), proximity of the donor tissue to the recipient (ie, local, regional, distant), and tissue composition (eg, musculocutaneous, fasciocutaneous) [1].

Medical Definition

bilobed. adjective. bi·​lobed (ˈ)bī-ˈlōbd. : divided into two lobes.

Definitions of bilobed. adjective. having two lobes. synonyms: bilobate, bilobated compound. composed of more than one part.

What does it mean when the nucleus is bilobed? ›

A lobed quality inhering in a nucleus by virtue of the nucleus being divided into or having two lobes.

TRAM (transverse rectus abdominis muscle) flap is one of the most common types of flap surgery. The surgeon takes muscle and tissue from the lower belly and moves it to the chest area.

advantages • Provides excellent access. allows surgery to be performed on more than one or two teeth. produces no tension in the tissues, allows easy reapproximation of the flap to its original position and hastens the healing process. Disadvantages • Produces a defect in the attached gingiva (recession of gingiva).

Relative contraindications to rotational flap transfer include an increased risk of hemorrhage and active smoking. Smokers, in general, have a higher risk of developing complications following surgery. Specifically, they are at increased risk of flap necrosis, which means that other closure options may be preferable.

You will be sore in the breast and in the area where the flap was taken. You may have a pulling or stretching feeling in those areas. You can expect to feel better and stronger each day, although you may need pain medicine for a week or two. You may get tired easily or have less energy than usual.

DIEP flap or tissue flap breast reconstruction can be performed immediately following a mastectomy or as delayed reconstruction. Patients will be given general anesthesia before surgery. The surgery takes four to six hours, but it can take longer if performed along with a mastectomy.

The advantages of Free Flap Procedure are: The coverage achieved by free flap surgery is very stable, and there are very few chances of breakage or damage to the flap. The chances of the donor site developing an infection or a disease are also minimal since both sites are less exposed to threats.

Conclusions: BMI, smoking, and operative time were identified as independent risk factors for free flap failure among all flaps or within flap subsets.

Disadvantages of the flap include the longer operative time and the more difficult dissection.

The main limitations of invasive flap monitoring technologies include the need for complex operative technique, unsuitable equipment design and malfunction, and high cost. The limitation of unsuitable equipment design and malfunction is common to all invasive monitoring techniques.

What is the success rate of flap reconstruction? ›

Results. Overall flap success rate was 90%, with the radial forearm flap occurring to be most reliable (93%) in head and neck reconstruction.

This is known as a “complete flap failure.” If you originally had a delayed reconstruction (when the reconstruction surgery takes place some period of time after the mastectomy), you'll lose some breast skin that was part of the transplanted flap when the flap is removed.

Vascular occlusion (thrombosis) remains the primary reason for flap loss, with venous thrombosis being more common than arterial occlusion. The majority of flap failures occur within the first 48 hours.

As with any major surgery, DIEP flap surgery also has risks. Common risks from major surgeries can include excessive bleeding, infection, the wound opening, asymmetry, and deep vein thrombosis.

You will probably see your provider to have your dressing changed in 4 to 7 days. You may need to have the dressing to your flap or graft site changed by your provider a couple times over 2 to 3 weeks. As the site heals, you may be able to care for it at home.

Flap Necrosis

Proper flap design and plane of elevation, careful handling of the flap, and the avoidance of flap desiccation intraoperatively are all important factors for the prevention of this complication.

Skin flaps are thought to provide better cosmetic results than skin grafting (Fig. 5), as the skin tone and texture are usually better matched. Additionally, they have a reduced chance of failure in comparison to skin grafts.

Most patients experience some discomfort after a flap procedure. Depending on your needs, we may prescribe pain medication or recommend over-the-counter medicine. It is important to relax after surgery, as strenuous activity may cause the treated area to bleed.

The tip of your nose will feel numb as nerves to sensation have to be cut. The sensation to this area usually returns after about 3 months as the nerves regrow but some people may still have an area of numbness over the nasal tip.

Plastic surgeries, especially rhinoplasty treatments, have been known to go wrong for many reasons. Sometimes it can be because of mistakes made by the surgeon. It can also be because the patients do not do their research properly before going through the procedure and so, are unsatisfied with the results.

Should I massage my nose after surgery? ›

Since the nose retains fluid (for up to a year) following surgery, the massaging motions and compression help push the edema or tissue fluid out of the skin and subcutaneous tissues. This can help mold the nose into a more refined, narrow shape as well as straighten the nose.

It is amazing how quickly the body heals after cosmetic surgery. The first week is the most critical period for rhinoplasty healing. After 7-10 days, patients can begin to use other sleeping positions.

Bending over is not recommended for at least three weeks, as this can increase swelling and aching. Avoid exercise for the allotted timeline of four to six weeks, and avoid activities that will be likely to injure or damage your nose.

You can usually treat a broken nose yourself. It should start getting better within 3 days and be fully healed within 3 weeks.

3-6 months: The numbness and abnormal sensations in your nose and nasal skin should be resolved. 1 Year: The healing process is complete – swelling should have subsided entirely and the nose's new shape is fully refined.

The bone doesn't grow after maturity, but the cartilage continues growing for the rest of your life. As such, over several years and decades, your nose will appear larger than it was during the surgery, and that's inevitable. However, you don't have to worry about this for several decades.

An abdominal flap is tissue that's taken from your abdomen. Abdominal flaps use skin, fat, and sometimes muscle. Surgeons can use an abdominal flap to reconstruct a breast in women who have extra abdominal tissue. Abdominal flaps are often used as a free flap.

Posterior Pharyngeal Flap (PPF) is a surgery done to help correct velopharyngeal dysfunction, or VPD. VPD occurs when the soft palate cannot properly separate the back of the mouth from the nose during speech.

Septum. This is a thin wall made of cartilage and bone. It divides the inside of the nose into 2 parts. Mucous membrane.

What are the complications of nasal flap surgery? ›

Mean follow-up time was 42 months. There were 50 (25.4%) patients who developed a complication, including impaired nasal function (18.8%), distal flap necrosis (5.1%), infection (2.5%), poor donor site healing (2.5%) wound dehiscence (2.0%), and flap congestion (1.5%).

You will need to follow the following guidelines until your incisions completely heal. This is usually 6 weeks after your surgery. Your doctor will tell you how long to follow these guidelines for. Keep your surgical sites out of the sun.

The risks associated with Pharyngeal Flap Surgery are: Around 20% cases of successful pharyngeal flap surgery reported the development of hypernasal speech. Apart from this, other surgical risks such as allergic reaction to anaesthesia, and slight bleeding may happen.

NO straws or sharp utensils for 2 weeks.

No swimming until cleared by your surgeon. Your child may snore after this surgery, which is normal and generally improves as the swelling decreases. Your child's speech may take up to a year to improve following surgery. Speech therapy can begin 4-6 weeks after surgery.

Cartilage, which covers and cushions the surface of joints, generally does not regenerate once damaged, but "cartilage cells from the nasal septum (the part of the nose that separates the nostrils) are known to have a great capacity to grow and form new cartilage."

Can A Septal Perforation Heal On Its Own? Sometimes, depending on the size of the septal perforation, it may heal on its own. However, as the size increases, the likelihood of spontaneous resolution decreases. A proper nasal septal perforation repair is important because of the delicate nature of the tissue.

Orbital involvement in endoscopic sinus surgery occurs in 0.5%⁶⁴ to 3% of all procedures, and represents 16% to 50% of all complications. Most common risks encountered in endoscopic sinus surgery include bleeding, infection, injury to the eye and its adnexa, cerebrospinal fluid leak, anosmia etc.

Avoid bending over and lifting heavy objects (over 5 pounds) during the first two to three weeks after surgery. These activities place pressure on the operative site and may cause bleeding.