The facial region has always posed a challenge in terms of the type of flap that could be used to cover facial defects secondary to multiple etiologies. Over time, the search has been on for a highly versatile flap, either because it can be harvested from multiple sites or because it provides security in terms of irrigation. One example is the bilobed flap for nasal reconstruction, which can be used over time with great versatility in different sites on the face. This flap is characterized by two lobes that share a single vascular pedicle, allowing for rotational coverage of defects with minimal risk of necrosis. While its traditional use was primarily for nasal defects, recent modifications and clinical adaptations have expanded its application to atypical facial locations such as the cheek, temporal region, and mandible. This report presents a clinical case of an 85-year-old male patient with a long-standing, non-painful hyperpigmented lesion on the right cheek, which was diagnosed as a moderately differentiated squamous cell carcinoma. Due to the lesion's size and involvement of multiple facial subunits (zygomatic, temporal, and maxillary regions), a wide local excision was performed in conjunction with intraoperative pathology. Reconstruction was achieved using a bilobed flap sourced from the cheek. The surgical plan was designed to ensure the preservation of both function and facial aesthetics, critical considerations in geriatric oncology patients. The discussion highlights the anatomical and vascular considerations essential for flap viability, including the rich vascular supply of the cheek from the transverse facial artery, facial artery perforators, and infraorbital branches. It also addresses the importance of preserving the facial nerve during flap elevation. The bilobed flap's advantages, such as minimal donor site morbidity, predictable vascular supply, and good cosmetic outcomes, make it particularly suitable for elderly patients with comorbidities who may not tolerate more extensive reconstructions. In conclusion, the bilobed flap remains a reliable and adaptable reconstructive technique for facial defects, including those resulting from oncologic resections. This case reinforces its utility in non-traditional locations and underlines the importance of individualized surgical planning. With proper anatomical understanding and technique, the bilobed flap offers an effective solution for restoring both form and function in complex facial reconstructions.
Pérez et al. (Thu,) studied this question.