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Bilobed fasciocutaneous flap
EriM Journal of PlasricSurgery( 1985) 38, 5 15-5 I7 (“1 1985 The Trustees of British Association of Plastic Surgery
Bilobed fasciocutaneous flap Y. MARUYAMA Department
of Plastic and Reconstructive
Surgery,
Toho University
Hospital,
Tokyo, Japan
Summary-The use of a bilobed fasciocutaneous flap in the reconstruction of lower leg defects is described. Two successful cases and the advantages of the bilobed fasciocutaneous flap in lower leg reconstruction are emphasised. Case 1
The versatility of the fasciocutaneous flap is now well known. Usually, the donor site of the fasciocutaneous flap requires delayed or immediate free skin grafting (Pontitn, 1981). In this report we describe a one stage repair of a lower leg defect using a bilobed fasciocutaneous flap which can make a free skin graft unnecessary.
Figure
I-
Case
1.Defect
Fig. 1 of the leg and design
of the bilobed
A 47-year-old female presented with ulceration over the lower leg extending to the tibia1 bone as a result of a motorcycle accident. Under spinal anaesthesia, the margins of the ulcer were excised down to healthy tissue and
a bilobed Fdsciocutaneous flap was planned and designed lateral to the defect (Fig. I). The first fasciocutaneous
fasciocutaneous 515
flap. Figure
Fig. 2 Z-Result after
surgery
516
BRITISH JOURNAL OF PLASTIC SURGERY
Fig. 3
Fig. 4
Figure 3--Case 2. Wide excision of skin carcinoma and design of the first fas~iocutaneous flap. Figure 4---Result after bilobed flap transfer.
flap was rotated into the original defect and the second was rotated into the second donor defect produced by the first flap. The donor site defect of the second flap was dosed directly. The patient’s post-operative course was uneventful and all the wounds healed primarily (Fig. 2).
Case 2 A 73-year-old man presented with a squamous cell carcinoma on the left leg (Fig. 3). After wide excision of the carcinoma including underlying fascia and periosteum, we found that the wound could not be closed ~rimarjiy or grafted with skin. A faseiocutaneous Rap was raised to close the defect. However, primary closure of the flap donor site was impossible, and to close the donor defect produced by the first flap, a second flap was designed. The donor defect of the second flap was closed primarily (Fig. 4). The patient did well and all the wounds healed without compIication.
The fasciocutaneous flap is very useful for repairing lower leg soft tissue defects and has an excellent
track record (Ponttn, 1980; Barclay, 1982) but the donor site defect usually needs to be skin grafted. The bilobed flap used for closure of smaller defects in other parts of the body has been described by several authors (Zimmany, 1953; Maruyama et al., 1980; Lynch, 1981; McGregor and Soutar, 1981). In our cases we combined this principle with that of the fasciocutaneous flap on the leg and avoided the need for a secondary skin graft to the donor area of the flap. References Barclay, T. L. (1982). Repair of lower leg injuries with fasciocutaneous Asps. British ~ourn(~lqf Plastic Szqer~, 35. 127.
BILOBED FASCIOCUTANEOUS
Lynch, S. .%I.(1981). The bilobed tensor fasciae latae myocuta~neousflap. Plastic and Reconstructive Surgery, 61,796. Maruyama. Y., Nakajima, H. and Kodaira, S. (1980). Primary
reconstruction of perineal defect with a bilobed myocuta-
neous flap. British Journal qf Plastic Surgery, 33.440. McGregor, J. C. and Soutar, D. S. (1981). A critical assessment of the bilobed flap. British Journal qf Plastic Surgery, 34, 197. Ponth, B. (1981). The fasciocutaneous flap: its use in soft tissue defects of the lower leg. British Journal of Plastic Surgery, 34, 215. Zimany, A. (1953). The bilobed flap. Plastic and Reconstructive Surgcr),. 11,424.
517
FLAP
TheAuthor Yu Maruyama, MD, Assistant Professor and Chief, D,epartment of Plastic and Reconstructive Surgery, Toho University Hospital, Tokyo, Japan. Requests for reprints to: Yu Maruyama, Department of Plastic and Reconstructive Surgery, Toho University Hospital, 6-l l-l Ohmorinishi, Ohtaku, Tokyo 143, Japan.
Bilobed fasciocutaneous flap Y. MARUYAMA Department
of Plastic and Reconstructive
Surgery,
Toho University
Hospital,
Tokyo, Japan
Summary-The use of a bilobed fasciocutaneous flap in the reconstruction of lower leg defects is described. Two successful cases and the advantages of the bilobed fasciocutaneous flap in lower leg reconstruction are emphasised. Case 1
The versatility of the fasciocutaneous flap is now well known. Usually, the donor site of the fasciocutaneous flap requires delayed or immediate free skin grafting (Pontitn, 1981). In this report we describe a one stage repair of a lower leg defect using a bilobed fasciocutaneous flap which can make a free skin graft unnecessary.
Figure
I-
Case
1.Defect
Fig. 1 of the leg and design
of the bilobed
A 47-year-old female presented with ulceration over the lower leg extending to the tibia1 bone as a result of a motorcycle accident. Under spinal anaesthesia, the margins of the ulcer were excised down to healthy tissue and
a bilobed Fdsciocutaneous flap was planned and designed lateral to the defect (Fig. I). The first fasciocutaneous
fasciocutaneous 515
flap. Figure
Fig. 2 Z-Result after
surgery
516
BRITISH JOURNAL OF PLASTIC SURGERY
Fig. 3
Fig. 4
Figure 3--Case 2. Wide excision of skin carcinoma and design of the first fas~iocutaneous flap. Figure 4---Result after bilobed flap transfer.
flap was rotated into the original defect and the second was rotated into the second donor defect produced by the first flap. The donor site defect of the second flap was dosed directly. The patient’s post-operative course was uneventful and all the wounds healed primarily (Fig. 2).
Case 2 A 73-year-old man presented with a squamous cell carcinoma on the left leg (Fig. 3). After wide excision of the carcinoma including underlying fascia and periosteum, we found that the wound could not be closed ~rimarjiy or grafted with skin. A faseiocutaneous Rap was raised to close the defect. However, primary closure of the flap donor site was impossible, and to close the donor defect produced by the first flap, a second flap was designed. The donor defect of the second flap was closed primarily (Fig. 4). The patient did well and all the wounds healed without compIication.
The fasciocutaneous flap is very useful for repairing lower leg soft tissue defects and has an excellent
track record (Ponttn, 1980; Barclay, 1982) but the donor site defect usually needs to be skin grafted. The bilobed flap used for closure of smaller defects in other parts of the body has been described by several authors (Zimmany, 1953; Maruyama et al., 1980; Lynch, 1981; McGregor and Soutar, 1981). In our cases we combined this principle with that of the fasciocutaneous flap on the leg and avoided the need for a secondary skin graft to the donor area of the flap. References Barclay, T. L. (1982). Repair of lower leg injuries with fasciocutaneous Asps. British ~ourn(~lqf Plastic Szqer~, 35. 127.
BILOBED FASCIOCUTANEOUS
Lynch, S. .%I.(1981). The bilobed tensor fasciae latae myocuta~neousflap. Plastic and Reconstructive Surgery, 61,796. Maruyama. Y., Nakajima, H. and Kodaira, S. (1980). Primary
reconstruction of perineal defect with a bilobed myocuta-
neous flap. British Journal qf Plastic Surgery, 33.440. McGregor, J. C. and Soutar, D. S. (1981). A critical assessment of the bilobed flap. British Journal qf Plastic Surgery, 34, 197. Ponth, B. (1981). The fasciocutaneous flap: its use in soft tissue defects of the lower leg. British Journal of Plastic Surgery, 34, 215. Zimany, A. (1953). The bilobed flap. Plastic and Reconstructive Surgcr),. 11,424.
517
FLAP
TheAuthor Yu Maruyama, MD, Assistant Professor and Chief, D,epartment of Plastic and Reconstructive Surgery, Toho University Hospital, Tokyo, Japan. Requests for reprints to: Yu Maruyama, Department of Plastic and Reconstructive Surgery, Toho University Hospital, 6-l l-l Ohmorinishi, Ohtaku, Tokyo 143, Japan.