A Guide To Using Bilobed Flaps In Lower Extremity Surgery

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Peter A. Blume, DPM, FACFAS

   The median total time to heal was 30.8 ± 40 days.12 Ninety-seven percent of the wounds healed. The recurrence rate of ulceration was 10.4 percent (seven of 67) over a time span of up to six years. All but one patient returned to previous levels of ambulation and many patients had improved levels of ambulation. The single-stage approach eliminated the need for additional surgical procedures with their associated costs and risks. In addition, healing times were significantly shorter, resulting in decreased hospital stays and subsequent costs, and providing the patient with an expedient return to footwear so surgeons could restore bipedal function. Most importantly, by addressing the underlying bony pathologic findings, surgeons saw dramatically lower recurrence rates.

In Conclusion

Bilobed flap reconstruction for lower extremity reconstruction is a viable option for foot and ankle surgeons. The geometric construct of the bilobed flap allows for superb versatility. A bilobed flap should be included in the reconstructive ladder as an option for defect closure and reconstruction.13 The long-term reproducibility and functional outcome of the bilobed flap are quite predictable. This flap does not typically require additional skin grafting and allows for primary closure. In addition, the advantage of the bilobed flap is that it will also reduce the typical hospitalization that occurs with many of these complex wounds. Surgeons can also use local anesthesia for bilobed flaps, therefore reducing morbidity and mortality.

   Dr. Blume is an Assistant Clinical Professor of Surgery in the Department of Surgery and an Assistant Clinical Professor of Orthopaedics and Rehabilitation in the Department of Orthopaedics, Section of Podiatric Surgery at the Yale University School of Medicine in New Haven, Ct. Dr. Blume is a Fellow of the American College of Foot and Ankle Surgeons.

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2. Sanchez-Conejo-Mir J, Buneo Montes J, Moreno Giminez JC, Camacho-Martinez F. The bilobed flap in sole surgery. J Dermatol Surg Oncol. 1985; 11(9):913-7.
3. Gillies HD. The design of direct pedicle flaps. Br Med J. 1932; 2(3752):1008.
4.  Esser JFS. Gestielte loakle Nasenplastik mit zweizipfligen Lappen, Deckung des sekundaren Defektes vom ersten Zipfel durch den Zweiten. Dtsch Zschr Chir. 1918;143:385.
5.  Zimany A. The bi-lobed flap. Plast Reconstr Surg (1946). 1953; 11(6):424-34.
6.  Bouché RT, Christensen JC, Hale DS. Unilobed and bilobed skin flaps. Detailed surgical technique for plantar lesions. J Am Podiatr Med Assoc. 1995; 85(1):41-8.
7. McGregor JC, Soutar DS. A critical assessment of the bilobed flap. Br J Plast Surg. 1981; 34(2):197-205.
8. Blume PA, Key JJ. Skin Grafts. In: Dockery GL, Crawford ME (eds.) Lower Extremity Soft Tissue and Cutaneous Plastic Surgery. Saunders/Elsevier, Philadelphia, 2006, pp. 151-171.
9.    Yetkin H. Bilobed flaps for nonhealing ulcer treatment. Foot Ankle Int. 2003; 24(9):685-9.
10. Blume PA, Moore JC, Novicki DC. Digital mucoid cyst excision by using the bilobed flap technique and arthroplastic resection. J Foot Ankle Surg. 2005; 44(1):44-8.
11. Jager T, Vogels J, Dautel G. The Zitelli design for bilobed flap applied on skin defects after digital mucous cyst excision. A review of 9 cases. Tech Hand Up Extrem Surg. 2012; 16(3):124-6.
12. Blume PA, Paragas LK, Sumpio BE, Attinger CE. Single-stage surgical treatment of noninfected diabetic foot ulcers. Plast Reconstr Surg. 2002 Feb; 109(2):601-5.
13. Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg. 2011; 127(Suppl 1):205S-212S.

   For further reading, see “A Closer Look At Plastic Surgery Techniques” in the March 2003 issue of Podiatry Today. To access the archives, visit www.podiatrytoday.com.

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