Rhomboid Flap Research Articles

Observation on the clinical effect of self-designed modified rhomboid skin flap in facial wound repair

Objective: To investigate the clinical effect of self-designed modified rhomboid flap in repairing rhomboid, round, and teardrop-shaped wounds on the face. Methods: A retrospective observational study was conducted. From August 2018 to April 2020, 30 patients with facial lesions admitted into Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the People's Hospital of Jianchuan County in Yunnan province met the inclusion criteria, including 16 males and 14 females, aged 23 to 88 years. The wound area ranged from 1.0 cm×1.0 cm to 7.0 cm×5.0 cm, with 10 cases of rhomboid wounds, 12 cases of round wounds, and 8 cases of teardrop-shaped wounds. The self-designed modified rhomboid flaps were applied to repair the wounds and after that, the patients were followed up for 1 to 18 months to record the survival of flaps, wound tension, scar formation and complications after surgery. Results: No necrosis or blackening was observed at the tip of the flaps after surgery. All the flaps survived and the wounds healed well with little tension, minimal scars, and no complications. Conclusions: The self-designed modified rhomboid flap is especially suitable for facial wounds with multiple important organs, multiple anatomical subunits, and areas with large changes in soft tissue tension, which can reduce not only the rotation of the flap, but also unnecessary excision of normal skin and soft tissue.

Aesthetic Unit-Based Reconstruction of Facial Defects with Local Flaps after Surgical Excision of Basal Cell Carcinoma

Background: Basal cell carcinoma (BCC) represents themost common type of facial skin cancer in Middle East andEgypt. It rarely metastasizes, but because of its locally destructivenature, it can cause high morbidity. Reconstructionby local flap after surgical excision depends on the size ofthe defect and the affected facial aesthetic unit.Aim: To reveal the prevalence of facial BCC, relation ofits site to facial aesthetic units and type of local flaps usedfor reconstruction per units.Patients and Methods: A retrospective study was conductedon 80 patients with facial BCC that admitted to the outpatientclinic, Plastic Surgery Department, Qena University Hospitalfrom June 2018 to May 2020 (2 years duration). Only earlystageand primary tumors were included. Statistical analysis:Data was analyzed using the Statistical Package for SocialSciences (SPSS) version 24. A p-value significant.Results: 80 patients with facial basal cell carcinoma (BCC)were collected from medical records. 45 (56.25%) patientswere males and 35 (43.75%) patients were females (M:F =1.3:1). Ages ranged from 52-78 years old (SD = 65±13).Nodular subtype was the most common clinical type of BCCand presented in 45 (56.25%) patients. Nasal unit was themost common site in 18 (22.5%) patients. The most randomflap applied was the rhomboid (Limberg) flap in 15 cases.The most axial flap used was the nasolabial flap in 9 cases.Complications (6 cases, 7.5%) included: Wound dehiscencein 3 cases, infection in 2 cases and skin slough in 1 case. TheSCAR scale score result ranged from 0-2 score.Conclusion: Facial defects reconstruction after surgeryfor basal cell carcinoma is a complex endeavor that requirescareful consideration. There are many different local flapsavailable depending on the particular facial subunit thatrequires reconstruction. Careful recognition of the principlesof the facial subunits will equip the surgeon to achieve thebest possible functional and aesthetic outcomes.

Versatility of Local Skin Flaps in Facial Reconstruction after Resection of Malignant Cutaneous Tumors

Background: The most prevalent malignant tumors of the human face are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma. BCC constitutes more than three quarters of skin cancers of the face and the rest primarily consist of SCC. Objectives: The aim of our study is to describe different types of local cutaneous flaps that are versatile and reliable in reconstruction of post-oncological facial defects. Patients and methods: This prospective study was conducted on patients admitted to the Plastic Surgery Department, Qena Faculty of Medicine, South Valley University from May 2019 to May 2020 (one-year duration). A total of fifty patients with malignant tumors of facial skin were included in our study. Results: Twenty nine patients had reconstructed their defects by local random flaps, while 21 patients had reconstructed their defects by local axial flaps. The most random flap applied was rhomboid flap in 14 (28%) patients The most axial flap applied was forehead flap in 6 (12%) patients and nasolabial flap in 6 (12%) patients . Conclusion: The reconstruction of post ablative face defects, using local flaps, is a real challenge from the perspective of surgical techniques, considering the difficulties determined by the restoring of three dimensional structures and the complexity of reconstructive methods.

A 3-days old infant with neonatal soft tissue sarcoma: a case report

Background :The incidence of sarcomas occurs in less than 1% of all malignant tumors but sarcoma is the cause of 2% of total cancer deaths. Based on the National Registry the incidence of neonatal sarcomas is 2.6 per million live births.Case Description : A baby girl aged 3 days, complaining of a mass on the patient's left thigh since birth. the mass was large from birth and there was only one on the left thigh. In the prenatal history, the mother and baby with routine ANC history to the midwife, and never having a control with an obstetrician, the mother was not sick during pregnancy and took medication during pregnancy outside of a doctor's prescription. In the perinatal history, the baby was born to mother G1P1A0, gestational age at term, was born by cesarean section, with birth weight 2800 grams, was born crying, active movement, reddish color, vomiting (-) genitalia (+) anus (+)Conclusion : Soft tissue sarcomas (STS) require proper diagnosis and management. The results of rhomboid flap in the tumor resection area are better than skin grafts of similar shape and location and provide cosmetic advantages with very few complications.

Geometry and design of a rhomboid flap

The rhomboid flap is a versatile random-pattern transposition flap with many clinical applications and has been adapted in many variations. The rhombic area of excision is associated with an area of “waste”, while adapting Quaba’s “square peg into a round hole” design is associated with the “pin-cushioning” effect. Using trigonometric calculations, we outline the association between different rhombic areas of excision and “waste”, and a method to design a classical Limberg rhomboid flap.

RECONSTRUCTION OF FACIAL SKIN DEFECTS BY VARIOUS LOCAL FLAPS IN RURAL INDIA

INTRODUCTION: Face is the index of mind. Facial deformities affect the impression of an individual. For larger defects or in situations where direct suture is neither applicable nor available, facial skin defects in the head and neck can be filled by free grafts, local skin flaps or either pedicled or free tissue transfer. METHODOLOGY: A prospective observational study was conducted to study different facial skin defects, their etiological factors, reconstructive techniques using local flaps and outcome of reconstructed flaps. The study was conducted on 53 patients between 2-70 years, comprising of 30 males and 23 females with facial skin defects due to various etiologies, willing to undergo reconstructive procedure using local flaps presenting at a tertiary care hospital for a duration of 18 months. RESULTS: Reconstruction was done using 18 (33.96%) rhomboid flaps,16 (30.19%) linear advancement flaps, 5 (9.43%) V-Y advancement flaps, 5 (9.43%) cervicofacial advancement flap, 9 (16.98%) nasolabial flaps. After surgery, all patients were assessed on post operative day 1, day 7, 4 weeks and 12 weeks for evaluation of outcome. All flaps survived on postoperative day 1. The ultimate cosmetic outlook at 12 weeks postoperatively is good in rhomboid flap and fair in all other flaps analysed in our study. CONCLUSION: Thus reconstruction by local flaps is an easy and cost effective technique, requires less hospital stay, can be performed even at remote places under local anesthesia with excellent functional and aesthetical results.

Fluoroscopy-induced chronic radiation dermatitis treated with excision and reconstructed with rhomboid flap

Fluoroscopy-induced chronic radiation dermatitis treated with excision and reconstructed with rhomboid flap

Surgical management of congenital hairy nevus of face with Limberg flap, a case report

Surgical management of congenital hairy nevus of face with Limberg flap, a case report - JOOO- Print ISSN No: - 2395-6186 Online ISSN No:- 2395-6194 Article DOI No:- 10.18231/2395-6194.2018.0049, Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology-J Oral Med Oral Surg Oral Pathol Oral Radiol

“Demographic profile and outcome of meningomyelocele in government medical college of Western UP”

Introduction: Meningomyelocele is a birth defect in which the backbone and spinal canal do not close before birth. Neural tube defects are one of the most common congenital malformations affecting the brain and spinal cord & Meningomyelocele is one of the commonest neural tube closure defects. The global prevalence of Meningomyelocele has been reported to be 0.8–1 per 1,000 live births. Hydrocephalus may affect as many as 80% of children with Meningomyelocele. The use of periconceptional folic acid supplements, prevents ~50–75% of cases of neural tube defects. This study aims to evaluate demographic and clinical profile, associated anomalies & outcome of children with Meningomyelocele. Materials and Methods: 113 patients with Meningomyelocele admitted to SVBP hospital, Meerut between Sept’16 to Aug’17, were analyzed prospectively. The data regarding demographic and clinical profile with associated congenital anomalies were obtained by questionnaire- interview with the parents and patients themselves. MRI was the essential investigation in all patients. The data was analyzed by SPSS 21.0 version. Results: Mean age of presentation is 9.1 months. M:F ratio is 1.1:1. Lumbosacral region is involved in 73.5% patients. Hydrocephalus was the most common (64.6%) associated anomaly. In 92% cases there is no history of folic acid supplementation & all patients were from low socioeconomic status. Excision & repair of Meningmyelocele is the most commonly (51.3%) performed surgery while surgical site infection is the most common (19.5%) complication. In our study (91.2%, n=103) patients improved & discharged, 2.7% (n=3) patients expired, 4.4% (n=5) patients left against medical advice while 1.8% (n=2) patients referred to higher centre due to various reasons. Conclusion: Low socioeconomic status & no maternal supplementation of folic acid are the important risk factors for the development of Meningomyelocele. Timely intervention with excision and repair gives good result. Modified rhomboid flap can be use to cover large defects. Keywords: Meningomyelocele, Hydrocephalus, Modified Rhomboid flap.

Combined Horizontal Split Gluteus Maximus Muscle and Fasciocutaneous Limberg Flaps for Reconstruction of Recurrent Sacrococcygeal Pilonidal Sinus.

Background:Pilonidal sinus is a chronic recurrent medical disease. The exact etiology of the disease is still unknown, but the most accepted theory is an acquired condition characterized by infected sinus in the natal cleft area containing a lifeless hair tuft. Multiple techniques were prescribed for its treatment; however, the ideal method is not yet defined.Methods:The study population includes 58 male patients who underwent excision of their recurrent pilonidal sinus, and the resulting defects were reconstructed using combined horizontal split gluteus maximus flaps and rhomboid flaps. Outcomes were revised from patient case files and followed up in our outpatient clinic and via questionnaires.Results:The mean hospital stay was 3 days. The mean time to return to work was 16 days. Partial wound dehiscences occurred in 2 patients. Distal end flap necrosis occurred in 1 patient. There were no flap losses, no recurrences, no infections, no loss of function, and no seromas during a mean follow-up period of 24 months. All patients were satisfied with the results.Conclusions:This technique has an operative time and hospital stays comparable to those of other techniques. It has minimal and acceptable complication rates and no recurrences. We can conclude that this procedure of combined split gluteus maximus muscle flap and rhomboid flap provides an excellent, effective, easy, and feasible method of choice for reconstructing defects of recurrent pilonidal sinus disease.

Anticipating local flaps closed-form solution on 3D face models using finite element method.

A realistic three-dimensional (3D) computational model of skin flap closures using Asian-like head templates from two different genders, male and female, has been developed. The current study aimed to understand the biomechanics of the local flap designs along with the effect of wound closures on the respective genders. Two Asian head templates from opposite genders were obtained to use as base models. A third-order Yeoh hyperelastic model was adapted to characterize as skin material properties. A single layer composed of combined epidermis and dermis was considered, and the models were thickened according to respective anatomical positions. Each model gender was excised with a fixed defect size which was consequently covered by three different local flap designs, namely advancement, rotation, and rhomboid flaps. Post-operative simulation presented various scenarios of skin flap closures. Rotation and rhomboid flaps demonstrated maximal tension at the apex of the flap for both genders as well as advancement flap in the female face model. However, advancement flap closure in the male face model was presented otherwise. Yet, the deformation patterns and the peak tension of the discussed flaps were consistent with conventional local flap surgery. Moreover, male face models generated higher stresses compared to the female face models with a 70.34% mean difference. Overall, the skin flap operations were executed manually, and the designed surgery model met the objectives successfully while acknowledging the study limitations. NOVELTY FILE: 3D head templates were considered to address the gap as 3D face models were uncommonly employed in understanding the biomechanics of the local flaps realistically. Most of the existing studies focus on the 2D and 3D planar geometry in their models. As gender comparison has yet to be addressed, we intended to fill this gap by exploring the stress contours of the local flap designs in different genders. Create a 3D face model from two opposite genders which is capable of simulating closure of wounds using local flaps with a focus on advancement, rotation, and rhomboid flaps.

Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap

Background: Pilonidal sinus disease is a common condition usually affecting young individuals and has been conventionally treated by open excision technique. Rhomboid Limberg is a transposition flap that has been pleaded for treatment of this condition. Aim: To study the outcome of Rhomboid excision with Limberg flap closure for the treatment of Sacrococcygeal Pilonidal sinus. Material and Methods: The study was conducted prospectively in the department of surgery Skims Medical College Srinagar from March 2014 to February 2019 and total of 55 patients with primary or recurrent pilonidal sinus disease were studied. Results: The average operative time was 60 minutes (range 50-80 minutes) Postoperative stay of patients in the hospital was 3-4 days.The complications were seen in total of four patients which included Seroma and mild gaping of the wound in one patient each and dehiscence in two patients. None of the patients had recurrence till date.Conclusions: Rhomboid excision with Limberg flap transposition is an effective surgical technique for management of pilonidal sinus. Keywords: Pilonidal sinus, Limberg flap, rhomboid transposition flap, fasciocutaneous flap,

Limberg flap versus primary closure in the treatment of sacrococcygeal pilonidal sinus

Pilonidal sinus describes a spectrum of clinical presentations, ranging from asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses of the sacrococcygeal region that have some tendency to recur. This study was undertaken in S.B.K.S.M.I.R.C, Pipariya, Baroda to compare the results of rhomboid excision followed by Limberg flap with that of excision and primary closure in patients diagnosed with pilonidal sinus. A total of 100 patients with pilonidal disease were randomly divided into group A who underwent excision and primary closure (n=50) and group B who underwent the rhomboid transposition flap procedure (n=50). Length of hospital stay and postoperative complications in two groups were compared. Duration of hospital stay (P

A tailored rhomboid mucocutaneous advancement flap to treat anal stenosis.

Anal stenosis (AS) is a rare but disabling disorder that often represents a complication of anorectal surgery. The aim of our study was to assess the safety and functional outcome of a modified rhomboid flap (MRF) in the treatment of moderate and severe AS. Between January 2002 and September 2017, 50 consecutive patients with moderate and severe AS who underwent an MRF were retrospectively included. Anal continence (Cleveland Clinic Incontinence Score) and symptoms (Obstructed Defaecation Syndrome Score) were assessed preoperatively and postoperatively at 12months. Furthermore, anal calibre was measured both preoperatively and postoperatively at 1, 6 and 12months. The mean follow-up period was 97±48.3 (33-180) months. The main aetiology was a previous excisional haemorrhoidectomy (N=23; 46%). The mean preoperative anal calibre was 9.96±2.68 (5-15) mm and there was a statistically significant improvement in all three periods (P<0.0001) of postoperative evaluation (1, 6 and 12months) with a mean difference, obtained comparing preoperative and 12months anal calibre, of 14.1 ± 2.72 (P<0.0001). Statistically significant improvement in both Cleveland Clinic Incontinence Score and Obstructed Defaecation Syndrome Score was observed in all patients at 12months. The overall success rate was 96% (48/50 patients). The use of an MRF is a safe and suitable option for the treatment of moderate and severe AS. The possibility of tailoring the flap, based on the degree as well as the level of AS, is the key.

Scalp Reconstruction With Three Rhomboid Flaps After Squamous Cell Carcinoma Excision

Scalp Reconstruction With Three Rhomboid Flaps After Squamous Cell Carcinoma Excision

Rhomboid Flap Reconstruction after Mastectomy for Locally Advanced Breast Cancer.

In patients undergoing mastectomy for locally advanced breast cancer (LABC), surgical skin flap reconstruction is sometimes required in order to cover large skin defects. This study assessed the efficacy of local, cutaneous (rhomboid) flap reconstruction after mastectomy by comparing data from patients with LABC requiring local flap reconstruction after mastectomy and those that underwent mastectomy alone. Data from 68 patients with LABC who underwent mastectomy were reviewed retrospectively; 14 underwent local (rhomboid) flap reconstruction after mastectomy (local flap group) and 54 underwent direct closure after mastectomy (direct closure group). A pinch test was performed to determine the closure method. Data on the operation, postoperative complications, and postoperative quality of life (QOL) were compared between groups. It was possible to close defects in the local flap group that were significantly larger than those in the direct closure group (p=0.0002). There was no significant difference in postoperative complications between groups. Although operative duration was significantly longer in the local flap group than in the direct closure group (p=0.016), the average difference was only 25 minutes. There was no significant difference in variables related to postoperative QOL. Rhomboid flap reconstruction was effective for covering large defects after mastectomy in patients with LABC.

A Simplified Approach to Myelomeningocele Defect Repair.

Repair of the soft tissue defect in myelomeningoceles remains challenging. The literature currently lacks a systematic approach, reporting high rates of complications. We present outcomes from the largest series to date and describe a simplified approach that minimizes morbidity and streamlines decision making. Patients 1 year or younger who underwent myelomeningocele repair between 2008 and 2018 were reviewed. Flap types were categorized by tissue composition. Complications were dichotomized into early and late (<30 days and >30 days postoperative, respectively). Logistic regression was used to measure the impact of flap tissue composition and skin closure technique on odds of postoperative complications. Ninety-seven patients met inclusion criteria. Reoperation was required in only 3 (3.0%) patients-1 for wound dehiscence and 2 for surgical site infections. Zero cases of tethered cord or cerebrospinal fluid leak occurred. The most common minor complications were early wound complications (n = 18, 18.6%) and early infection (n = 5, 5.2%). Fascia-only flaps and muscle + other tissue flaps were not associated with higher odds of complications compared with muscle-only flaps (odds ratio [OR], 2.13; 95% confidence interval [CI], 0.53-8.50, P = 0.29; OR = 2.87, 95% CI 0.66-12.51, P = 0.16, respectively). Rhomboid flaps for skin closure were associated with higher odds of complications (OR, 4.47; 95% CI, 1.00-19.97; P = 0.05). Our approach to myelomeningocele repair demonstrated no cases of secondary tethered cord or cerebrospinal fluid leak, and reoperative rates were extremely low. Because complications were unrelated to flap type, we recommend a simplified approach using any tissue type for dural coverage and 2-layer primary closure of the skin.

Rhomboid Flap: Best Option for Skin Defects of All Sizes? A Comprehensive Review of Literature

Rhomboid Flap: Best Option for Skin Defects of All Sizes? A Comprehensive Review of Literature

Combined Horizontal Split Gluteus Maximus Muscle Flap and Fasciocutaneous Limberg Flap for Reconstruction of Recurrent Sacrococcygeal Pilonidal Sinus

disease. The exact etiology of the disease is still unknownbut the most accepted theory is an acquired condition characterizedby infected sinus in the natal cleft area contains lifelesshair tuft. Multiple techniques were prescribed for its treatmenthowever the ideal method still not yet defined.Patients and Methods: Fifty eight male patients whounderwent excision of their recurrent pilonidal sinus diseaseand the resulting defects were reconstructed using combinedhorizontal split gluteus maximus flaps and rhomboid flaps.Outcomes were revised from patient's files case and followedup in outpatient clinic and via questionnaires.Results: The mean hospital stay was three days. The meantime to return to work was 16 days. Partial wound dehiscence'soccurred in two patients. Distal end flap necrosis occurred inone patient. There were no flap losses, no recurrences, noinfections, no loss of function and no seromas during a meanfollow-up period of 24 months. All patients were satisfiedwith the results.Conclusion: In comparison with other techniques, it hasa comparable operative time and hospital stays. It has minimaland acceptable complication rates and no recurrences. We canconclude that this procedure of combined split gluteus maximusmuscle flap and rhomboid flap provides an excellent, effective,easy and feasible method of choice for reconstructing defectsof recurrent pilonidal sinus disease.

WIDE EXCISION AND RHOMBOID FLAP RECONSTRUCTION FOR TREATMENT OF COMPLEX PILONIDAL DISEASE. CASE SERIES AND REVIEW OF LITERATURE.

Introduction: Pilonidal disease a chronic inflammatory disorder affecting the sacrococcygeal region with superimposed infection. This problem can present with acute abscess or chronic discharging sinus and often difficult to treat due to high incidence of recurrence.&#x0D; We are presenting our case series of wide excision and rhomboid flap reconstruction of complex pilonidal sinus disease.&#x0D; Methods: This is a retrospective review of our series of patients who have had rhomboid flap reconstruction done in colorectal surgery department for complex pilonidal sinus disease. The time period between is 2003 to 2017. The review was conducted from our electronic data base in our hospital.&#x0D; Results: We had 50 patients in total. 30out of 50 have had previous surgery for pilonidal sinus disease. Five patients developed recurrence (10% recurrence rate). 4 out of 5 patients who had recurrence were smokers.4 out of 5 patients with recurrence had previous surgery for pilonidal disease. The median age of the patients was 28.The age ranged from 16 to 49 years. The median length of stay is about 4 days&#x0D; Conclusion: In conclusion Rhomboid flap reconstruction is a viable operation for complex pilonidal disease. The long term results are good. It can be safely performed by a general /colorectal surgeon with good results. It is a good option for complex pilonidal sinus and recurrent disease following multiple previous operations. The recurrence rate seems to be higher in smokers and in patients who had previous surgery in natal cleft.