The modified bilobed flap for reconstructing sacral decubitus ulcers

Background:Sacral pressure ulcers are associated with high morbidity and,in some cases,result in mortality from severe sepsis.Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers.An ideal flap should be simple to design,have a reliable vascular supply and minimal donor site morbidity.Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer.Case presentation:We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019.A description of our management,operative protocol,outcome and complications is outlined.Seven paraplegic patients(6 male,1 female;average age 53.1 years)with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery.The average size of the pressure ulcers was 7×5 cm(range 6.2×4.5 cm to 11×10 cm).All 7 flaps survived.The patients were followed up for 12 months without significant complications,such as flap necrosis or recurrence.Conclusions:The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap.The superior cluneal nerve can be included in the design.The technique is simple and reliable.It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.

A modified bilobed flap design for nasal tip defects

Aim:The correction of nasal tip defects presents many challenges.Zitelli’s bilobed flap has been widely used for such repairing defects,but may be complicated by interrupted scars on the nasal dorsum.Our study evaluates the design principles,results,and advantages of a modified bilobed flap for repairing nasal tip defects.Methods:The primary lobe was located between the defect and the cheek,and the second lobe was located in the cheek.The width of the primary lobe was equal to that of the primary defect.The length of the primary lobe was 10%longer than the distance of the distal defect edge to the pivot point of the flap.The length of the second lobe was 30%longer than the distance of the distal defect edge to the pivot point of the flap.The width of the second lobe was 90-100%of that of the primary lobe.The ability to close the defect under minimal tension,the cosmetic appearance,and any complications were evaluated.Results:This technique was performed in 34 cases;defect size ranged from 0.8 cm×0.9 cm to 1.2 cm×1.8 cm.All defects were closed under minimal wound tension,all scars were inconspicuous,no obvious complications occurred,and the aesthetic outcomes were considered favorable.Conclusion:The modified bilobed flap can provide satisfying outcomes with lower morbidity and inconspicuous scarring.It is simple and suitable for repairing small-to medium-sized defects in the nasal tip.