We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Design Aspect of the Bilobed Flap

John A. Zitelli, MD
Arch Facial Plast Surg. 2008;10(3):186. doi:10.1001/archfaci.10.3.186.
Text Size: A A A
Published online


Zoumalan et al1 demonstrate a very important design aspect of the bilobed flap: that closure of the secondary defect should be as vertical as possible to avoid distortion of the alar rim. In many published photographs of the bilobed flap, one can see that secondary closures that are not perpendicular to the alar rim will usually result in distortion to either the ipsilateral or contralateral alar rim.

Some clinical variables can help to predict the possibility of alar position postoperatively. First, the larger the primary defect, and therefore the larger the secondary defect, the more likely there will be distortion. This possibility is magnified if the skin is tight over the nasal dorsum and side walls, limiting the amount of skin available for closure. In the situation of large defects or tight skin, it is very important to orient the secondary defect perpendicular to the alar rim. One tip for repairing the nasal defects where the skin is tight is to undermine widely over both sidewalls to the nasofacial sulcus. There is a tight attachment of the skin to the deeper structures over the junction of the inferior margin of the nasal bone and the upper lateral cartilage. Once this fibrous band is severed during undermining, one can recruit much more skin from the medial cheeks and minimize the pull and distortion of the alar rim.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

4 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
PubMed Articles