Bilobe Flap
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This is Richard Allen at the University of Iowa. This video demonstrates the use of a bilobe flap for repair of a defect inferior to the medial canthus. The defect would be difficult to close with either a glabellar flap or horizontal myocutaneous flap. It is also too deep for a skin graft. A bilobe flap is planned so that the inferior donor site will be closed vertically to eliminate any vertical tension of the lower eyelid. A 15 blade is used to make an incision along the planned bilobe flap. Westcott scissors are then used to dissect the flap in the plane under the subcutaneous fat. Hemostasis can be obtained with either bipolar or unipolar cautery. Mobilization of the flap shows good coverage of the defect. The inferior donor site is then closed with deep interrupted 5-0 vicryl sutures. By doing this, the flap is transposed into position. The flap is then sutured into position with deep interrupted 5-0 Vicryl sutures. The closure places minimal vertical tension on the lower eyelid. The skin is then closed with 5-0 and 6-0 prolene suture, some placed in a vertical mattress fashion and some placed in an interrupted fashion.
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