The Bilobed Flap for Nasal Reconstruction
Since antiquity, there has been evidence of nasal surgeries. From battle wound repairs to perhaps more cosmetic fixes, rhinoplasty and reconstructive nasal surgeries have been around for a long time. It makes sense, as well, as the nose is arguably the most prominent facial feature. Located directly in the center of the face, any defects or anomalies tend to become a focal point. There are many reasons people have work done on their nose as well, from the ubiquitous nose job for purely cosmetic reasons, the internal procedures like septoplasty to help patients breathe better and the external work to repair damage from cancers, trauma, etc.
Many of the earlier procedures are still commonplace today, such as taking tissue from the forehead, cheeks or even from the arms or hips to rebuild or repair damage to the nose. From primitive ancient procedures repairing the damages from face to face combat to the more advanced and sterile operations of today, there has been much innovation and advancement in the field of nasal surgery. This doesn’t always mean more and more complicated procedures, though. Sometimes it is merely a simplification to an already well-established procedure.
In 1989, John A. Zitelli made such a modification to the classic bilobed flap nasal reconstruction technique. This procedure is common for removing carcinomas and other small areas that need surgical removal and repair of the remaining wound. The original design for the bilobed flap was two flaps located next to the site of removal. The first flap is used to cover the defect and the second, which was more elastic, was used to cover the wound from the first flap. While being effective, there was still a great potential for defects. Zitelli simplified this by changing the orientation of the bilobed flaps. He made the first circular flap 45° from the axis of the defect, down from 90°. And he changed the second more elliptical flap from 180° down to 90°.
This change greatly reduced the chances of deformities as a result of the surgery. As Zitelli said in his July 1989 article titled The Bilobed Flap for Nasal Reconstruction, “…orientations and emplacements eliminated the excess-flesh “dog ears”, and thus required a smaller area of donor skin; resultantly, the broad-based, bilobed flap is less prone to the “trap door” and the “pin cushion” deformities common to skin-flap transposition procedure.” With the reduced risk for these deformities and the skin of the nose being less prone to scarring, this new alteration to the already commonplace bilobed flap method of nasal reconstruction has now become the standard method.
With innovative improvements to techniques like the bilobed flap procedure and more and more technological advancements, time will only tell what the future of reconstructive nasal surgery and other surgeries holds.