Bilobed Flaps

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. The original flap used a rotational arc of 180 degrees and based the second lobe superiorly, towards the glabellar region. In 1953, Zimany demonstrated that the second and third lobes could be smaller than the first and that the flap could be utilized for reconstruction in more anatomical areas. In the 1980s, McGregor and Soutar introduced the concept that a reduced pivotal angle would result in smaller standing cutaneous deformities and decreased pincushioning. Zitelli went on to describe limiting the total rotational arc to between 90 and 110 degrees; this variant is the most common modification in use today. This overview of the bilobed flap will focus on the most recent modification. Herein, the relevant anatomy and the situations in which the bilobed flap is most effectively employed will be described, as well as how to plan and transfer this versatile flap.