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Category: Plastic surgery

The usefulness of the bilobed flap for lateral cheek defects

The usefulness of the bilobed flap for lateral cheek defects (part 6)

After the second lobe is elevated, the surgeon can inset the two lobes (Figure 9). The defect left from the second lobe should be closed primarily. Sometimes a Burrow’s triangle or V-Y advancement flap may be used to close this defect if the edges will not come together without tension. Trimming the flaps and the […]

The usefulness of the bilobed flap for lateral cheek defects

The usefulness of the bilobed flap for lateral cheek defects (part 5)

The second key step in this procedure is undermining the primary defect to avoid pin cushioning. Pin cushioning is caused by either an excessively large flap, or scar contraction, which leads to constricting forces developing along the inner aspect of a curved scar. With time, the tissue or flap within the curve bunches together and […]

The usefulness of the bilobed flap for lateral cheek defects

The usefulness of the bilobed flap for lateral cheek defects (part 4)

  Local anesthesia is used with epinephrine for hemostasis, creating a tumesencent bed over the entire surgical area including the defect, flaps both flaps and surrounding tissues that will need to be undermined to facilitate skin movement and closure. The local anesthetic will have time to take effect while the patient and the the surgical […]

The usefulness of the bilobed flap for lateral cheek defects

The usefulness of the bilobed flap for lateral cheek defects (part 3)

The two lobes of the skin flap are then planned and outlined adjacent to the lesion. The lobe distal to the wound is smaller in size than the proximal lobe. The bilobed flap is outlined with a surgical marker (Figure 3). The first or proximal lobe, used for reconstructing the defect, usually lies with its […]

The usefulness of the bilobed flap for lateral cheek defects

The usefulness of the bilobed flap for lateral cheek defects (part 2)

TECHNIQUE The lesion is identified (Figure 1) and marked with appropriate margins from the clinically visible tumour border (Figure 2). Loupe magnification may be used to help delineate the lesion border. The skin should be assessed for laxity, tethering and mobility. In this case, areas of laxity were assessed. Due to the nature of the […]

The usefulness of the bilobed flap for lateral cheek defects

The usefulness of the bilobed flap for lateral cheek defects (part 1)

Head and neck skin cancer excision and reconstruction provide endless challenges and opportunities for the reconstructive surgeon. There are many, well-documented methods of excision and reconstruction. These methods are based on the principles of the reconstructive ladder and on geometric principles. Factors such as tissue quality, size of defect and relevant anatomical structures, as well […]

The cardiac implications of breast reconstruction using the internal mammary artery as the recipient vessel (part 7)

Ischemic heart disease remains the most common cause of death for women in developed countries. Despite current trends in percutaneous coronary intervention and the recent popularity of drug-eluting stents, the strongest, most robust evidence with the longest follow-up still fervently supports coronary artery bypass surgery as the gold standard therapy for left main coronary artery […]

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