The Bilobed Flap - Critical Analysis and New Mathematically Precise Design.

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Dermatology

Background:

• The bilobed flap is a standard technique for lower nasal reconstruction.
• Previous modifications focused on flap dimensions, neglecting the pivot point's significance.
• This study critically examines the classic Zitelli bilobed flap design.

Purpose of the Study:

• To mathematically analyze the precision of the classic Zitelli bilobed flap design.
• To investigate the critical role of the pivot point in bilobed flap geometry and movement.
• To propose a mathematically refined bilobed flap design for nasal reconstruction.

Main Methods:

• Mathematical analysis of the bilobed flap design using drawing software.
• Critical evaluation of flap design and movement mechanics.
• Investigation of flap biogeometry through diagrams and mathematical principles.

Main Results:

• The classic bilobed flap design contains mathematical inaccuracies.
• A revised design with the pivot point at 2.6 times the defect radius ensures precise flap movement.
• Secondary flap extension is optional, and dog-ears can be managed independently.

Conclusions:

• The bilobed flap is essential for lower third nasal reconstruction.
• A mathematically precise bilobed flap functions primarily as a rotation flap.
• Optimizing the pivot point location to 2.6 times the defect radius enhances the flap's mathematical accuracy and reconstructive utility.