Rhomboid Flap for Large Cutaneous Trunk Defect

Abstract

Summary: Resection of large cutaneous malignancies may result in substantial skin defects. Often, skin grafting is a first-line option for reconstruction of such defects but may be limited by poor cosmetic outcomes and incomplete graft acceptance. Accordingly, skin flaps, tissue rearrangement techniques, and more complex procedures may be needed. This case report presents the successful use of a rhomboid flap for reconstruction of a 20 × 19 cm2-sized trunk skin defect left after a squamous cell cancer resection. The flap was quickly and easily fashioned, did not require any special instruments, and resulted in a good cosmetic outcome. There were no major wound complications despite postoperative radiation therapy. At 1-year follow-up, the flap healed completely with excellent contour, texture, thickness, color match, and complete patient satisfaction. In the past, rhomboid flaps have been used for small defects. This case is a unique example of a versatile and successful rhomboid flap reconstruction of an extremely large defect, instead of a more complicated reconstructive option.

Rhomboid flap scar assessment: A patient reported outcome study. A case series

“…We believe that reconstruction of each defect should be tailored to the unique characteristics of the defect, patient expectations, and surgeon's experience [ 15 ]. At times, primary closure and skin grafts may result in distortion, contour deformity, or unacceptable scarring making local flaps the preferable option [ 16 ].…”

Subcutan és intramuscularis heterotop kalcifikáció a nyakon 42 évvel a sugárkezelést követően

“…A sebészi rekonstrukció eszköztárába a különböző fasciocutan, myocutan és szabad lebenyek tartoznak. A fej-nyaki régió kis és közepes defektusainak zárására a romboid (Limberg-) lebeny sokoldalú, biztonságosan alkalmazható, egyénre szabható rekonstrukciós alternatíva, mely válogatott esetekben kiterjedt defektusoknál is megfelelő kozmetikai eredményt nyújt [30][31][32]. A sebész igénye szerint széles határok között formázhatja a lebenyt, fontos azonban kiemelni, hogy annak túlélése a környező szövetek minőségétől függ, melyek a hegesedés, a sugárkezelés és a vascularis elváltozások következtében nagymértékben károsodottak lehetnek.…”

Rhomboid flap: Indications, applications, techniques and results. A comprehensive review

“…The flap's pedicle maintains subpapillary and sub-dermal vascular plexuses to provide superior results when compared to skin grafts of similar size and location [ 12 , 13 ]. Larger sized rhomboid flaps may rely on perforator vascular supply [ 1 , 2 ]. A reduction in tension on the flap decreases the likelihood of necrosis of the donor tissue [ 14 ].…”

“…The application of this flap has been described in almost all parts of the body with extreme safety and good cosmetic result [ 1 , 8 ]. Traditionally, rhomboid flaps have been safely used to reconstruct small to moderately sized skin defects [ 2 ]. However, the authors have presented several cases where very large sized defects have been successfully reconstructed with rhomboid flaps [ 1 , 3 ].…”

“…The principle suggests that simplest effective technique should be considered first in reconstruction [ 1 ]. However, at times, primary closure or grafting techniques may lead to increased likelihood of dehiscence, distortion of key structures, poor cosmetic outcomes, or less-than-total graft acceptance [ 2 ]. In these situations, local flaps with the pliability, matching texture and color become the best option.…”