Double rhomboidal flap for reconstruction of large surgical defect of the labial commissure

Andrade, Pedro; Brinca, Ana; Vieira, Ricardo; Figueiredo, Américo

doi:10.1590/s0365-05962012000300015

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…These include those based on the classical principles of local flaps e.g. the double rhomboid flaps [3] and variants of the Webster-Barnard flap [4] . The former option is designed for commissural defects while choice of the latter would still subject the patient to difficult mouth opening.…”

Section: Discussionmentioning

confidence: 99%

The labio-mandibular flap for upper lip and peri-commissural defects

Kannan¹,

Nduka²

2018

PAR

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Aim: Peri-commisural defect reconstruction using the Abbe or Estlander flaps tend to pilfer tissue from the lower lip, contributing to microstomia, with its attendant problems. In this study, we aim to design a flap for more superficial defects, in which the underlying orbicularis oris muscle can be preserved when resecting peri-commisural skin malignancies whilst also ensuring completeness of excision. Methods:In a retrospective case review of 7 cases at our institution over a 12-month period (2016-2017), we conceptually designed a perforator-plus fascio-cutaneous flap from within the labio-mandibular fold with a 6-month follow-up in terms of oncological clearance and aesthetic outcome. The cohort was composed of patients with skin cancers e.g. basal and squamous cell carcinomas, presenting to a tertiary care facial plastic surgery centre. The technique involved raising a flap from within the peri-oral area, with a scar disguised along the labio-mandibular and naso-labial folds which allows for both an aesthetic reconstruction and the preservation of the oral sphincter mechanism, by avoiding microstomia. The outcomes measured were (1) to ascertain whether this procedure is oncologically safe, (2) there were instances of microstomia and (3) aesthetic appearance.Results: All oncological lesions were completely excised in all cases and at up to six months' follow-up, there were no instances of recurrence. Functionally, oral sphincter function was preserved in all instances as was aesthetic appearance. Conclusion:The labio-mandibular flap is an oncologically safe procedure for skin cancers whilst preserving oral sphincter function and maintaining aesthetics. It is hence, a superior alternative to Abbe and Estlander flaps, for more superficial defects, not requiring mucosal excision.

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Section: Discussionmentioning

confidence: 99%

The labio-mandibular flap for upper lip and peri-commissural defects

Kannan¹,

Nduka²

2018

PAR

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“… 1 Rhomboid opposing cutaneous flaps have been used for reconstruction of the nasal dorsum, albeit with extensive scarring, 2 lateral forehead, 3 and oral commissure. 4 Double opposing cutaneous flaps have been used successfully for shoulder and for medial thigh reconstruction, 5 and double opposing galeocutaneous flaps have been described for reconstruction of a large aplasia cutis congenita defect in a neonate. 6 Double opposing rhomboid fasciocutaneous flaps have been used successfully for large defects following excision of extensive complex pilonidal sinus disease.…”

Section: Introductionmentioning

confidence: 99%

Dufourmentel Flap for Scalp Reconstruction

Viciana

Lessard²

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Transposition flaps are useful for reconstruction of many skin defects. Limberg described a rhomboid rotation flap in 1946. Dufourmentel described an improved version of the Limberg flap in 1962. The Dufourmentel flap is also a quadrangular rhomboid flap which can be used in any area of the body except for the central face, the fingers, and the volar hand. The design of the Dufourmentel flap creates a wider base for this random flap, thus making it more reliable. Where tissue loss is significant, or where skin and soft tissue elasticity is limited, double opposing Dufourmentel flaps are useful. A variation of the Dufourmentel flap is described where a circular defect is converted to a square. The line of greatest extensibility is marked through the circular defect or lesion. A square is marked around the circle with one corner of the square tilted 10–20 degrees counterclockwise from the line of greatest extensibility. After marking corners A, B, C, and D, lines are marked extending BD and CD. The first incision, DE, will bisect the angle created by extending BD and CD. The second incision, EF, is roughly perpendicular to CD extended, but the angle at E is opened up a bit to create a wider base for the flap. Point D will rotate to point B, E rotates to C, and F translates to D. The invisible line DF should be approximately parallel to the line of greatest extensibility. When the defect is relatively large or where the surrounding tissues have limited elasticity, the above-described ideal variation of the Dufourmentel flap may not be possible because the flap may not rotate and advance all the way around without tension. In this case, double opposing Dufourmentel type flaps have been found to be useful by meeting each other at the halfway point.

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