๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Lengthening the primary lobe
Lengthening the primary lobe
Lengthening of the primary lobe of the flap to overcome pivotal restraint has been described as a strategy to better reach the distal edge of the primary defect and overcome pivotal restraint.21 The defects described in this report, however, were not the typical size or in the usual location for a bilobed flap.
When the bilobed flap is used to repair a defect on the nasal tip, the flap will naturally recruit skin from the medial cheek and nasofacial sulcus, obviating the need for an oversized primary lobe. Still in cases where the flap is large, so that closure of the tertiary defect causes tension near the medial canthus, a longer primary lobe may be useful.
Another strategy to mitigate the challenges of pivotal restraint is to design a long and narrow Burowโs triangle, approximately 1.5 times the diameter of the defect. If the Burowโs triangle is significantly shorter, as can occur by necessity with larger defects, pivotal restraint may present a greater challenge.22