๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Medially based bilobed flap
Medially based bilobed flap
When the defect appears too big for a bilobed flap, consider drawing the flap with the Burowโs triangle oriented medially, rather than laterally (Fig. 24-5).18 A contralateral or medially based bilobed flap is an easy solution for a large and deep defect, and for select small distal alar defects.19 Although the vascular supply is not as rich in these locations, due to an increased distance from the angular artery, medially based bilobed flaps are reliable. Importantly, design the flap with sufficient lobe length to accommodate draping over the convex midline. As with all large bilobed flaps, assure that there is adequate laxity on the upper two-thirds of the nose to permit closure of the tertiary defect.
Figure 24-5. Series of photos for medially based bilobed flap. Mohs defect too large for standard bilobed flap (A), immediately postrepair (B,C), and 3 months postoperative (D,E),