The Local Rhombus-Shaped Flap-An Easy and Reliable Technique for Oncoplastic Breast Cancer Surgery and Defect Closure in Breast and Axilla.

Primarily, breast-conserving therapy is an oncological intervention, but eventually it is judged by its cosmetic result. Remaining cavities from tumor resection can promote seromas, delay healing and cause lasting discomfort. Additionally, volume loss, dislocation of nipple/areola and fat necrosis lead to (cosmetically) unfavorable results, aggravated by radiotherapy.

Double Z-Rhombic Plasty for Repair of Scalp Defects.

Background: The closure of scalp wounds presents with reconstructive challenges due to the poor tissue elasticity. It is not uncommon to require skin grafts for definitive closure, even when large flaps are employed. Herein, we present a novel method for the direct closure of small- to medium-sized wounds defects.

Like Versus Unlike: Closure of a Moderate-sized Circular Tissue Defect Following Wide Local Excision of Primary Cutaneous Squamous Cell Carcinoma of Face by Rhombic Transposition Flap with Modification.

Closure of a circular tissue defect in the head-neck-face region is challenging because most transposition flaps are rhombic or triangular. For a tension-less closure, both rhombic transposition flap and the circular tissue defect need to be engineered maintaining strict geometric calculations. The present illustration demonstrates a modified rhombic transposition flap with greater freedom in rotation and mobility for closing a moderate-sized circular defect resulting from wide local excision of cutaneous squamous cell carcinoma in the mid-face.

Teaching Models for Correct Rhombic Flaps.

The aim of this study was to introduce teaching models for correct rhombic flaps. For the line of maximal extensibility (LME) and flap design, surgical fabric (model 1), scored corrugated cardboard (model 2), and scored polyethylene sheet (model 3) were used. For choosing the correct flaps, a silicone face (model 4) was used.

Simulation and optimization of reconstructive surgery procedures on human skin.

The complex procedures involved in the reconstructive surgery of human skin to minimize post-operative scarring are here modeled by means of an automated computational tool. A finite strain no-compression membrane model accounting for the tendency to develop wrinkling regions in the skin is presented. The constitutive behavior of the material is then described by a suitable hyperelastic incompressible potential.

Revisiting Rhombic Flaps for Aesthetic Facial Resurfacing: Addressing a Surgical Conundrum.

Background: Facial resurfacing is a surgical and aesthetic challenge, as it requires soft, pliable, and stretchable donor skin with a good match of color, texture, and thickness and minimum donor scarring. Rhombic flap is a highly versatile flap that has the aforementioned properties. Careful flap planning and execution is vital for successful outcomes.

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.

Rhombic Flap: A Useful Flap for Small-to-Medium Defects of the Medial Canthus.

Background: Medial canthal defects are frequently encountered yet present specific challenges for the reconstructive surgeon. Surgical repair in this area may inadvertently lead to canthal webbing, ectropion, and/or epiphora. The rhombic flap is a versatile workhorse in the reconstructive armamentarium for canthal defects.

[The Contralateral Double Transposition Flap].

Classic transposition flaps (TF) consist of a single random pattern lobe, which is elevated (rotated) over an area of normal skin to reach the primary defect. Frequently mentioned modifications are the rhombic flaps according to Limberg and Dufourmentel as well as the unilateral multi lobed ("bilobed" and "trilobed") flaps 1, 2, 3, 4, 5, 6. The contralateral double TF presented here is a modification rarely mentioned in the literature 4.

Flap Basics I: Rotation and Transposition Flaps.

In many cases of complex facial defects, because of advanced cutaneous malignancies, primary wound closure is impossible. In these instances, ideal results can be obtained through recruitment of adjacent tissue with the use of local flaps. Advances in local flap techniques have raised the bar in facial reconstruction; however, acceptable results to the surgeon and patient require high levels of planning and surgical technique.

[Classic Limberg Flap Procedure for Treatment of a Sacrococcygeal Pilonidal Sinus Disease - Explanation of the Surgical Technique].

Introduction: Sacrococcygeal pilonidal sinus disease is frequently encountered in surgical practice. Besides excision only, the current pilonidal sinus guideline of the Association of the Scientific Medical Societies in Germany (AWMF-S3) also recommends plastic surgical procedures such as the cleft-lift operation described by Bascom, the Karydakis flap procedure and, due to the low recurrence rates, the Limberg flap procedure, for the treatment of this disease.

Indication: In our case we show the surgical procedure performed on a 23-year-old male patient, who was previously treated for an acute abscess-forming sacrococcygeal pilonidal sinus.

From the rhombic transposition flap toward Z-plasty: An optimized design using the finite element method.

In this paper, an optimized design for rhombic transposition flaps is created using a reliable finite element model that assures convergence for stress and deformation results. Defining a general configuration for rhombic flaps, the surgical process of wound closure is simulated for a wide variety of patterns. To address the intrinsic uncertainties associated with modelling skin's mechanical properties, four different sets of material parameters are considered, to investigate statistical measures.

Biomechanics of the rhombic transposition flap.

Objective: To develop a computational model of cutaneous wound closures comparing variations of the rhombic transposition flap.

Study Design: A nonlinear hyperelastic finite element model of human skin was developed and used to assess flap biomechanics in simulated rhombic flap wound closures as flap geometric parameters were varied.

Setting: In silico.

Design principles for transposition flaps: the rhombic (single-lobed), bilobed, and trilobed flaps.

Background: When tension at a cutaneous defect is too great for primary closure or causes distortion of surrounding anatomy, transposition flaps provide a useful reconstruction option.

Objective: To review the tissue biomechanics of the rhombic, bilobed, and trilobed transposition flaps.

Materials And Methods: A systematic evaluation of a cutaneous defect is provided to guide a logical approach to the design and execution of transposition flaps.

[Early hypertrophic scar after surgery on the nasal region: value of long-acting corticosteroid injections].

Background: "Pincushioning" is a complication of post-surgical scarring following use of transposition flaps particularly when surgery is performed on the nasal region. The transposition flap technique is very useful for the repair of certain defects of the tip of the nose, the medial canthus or of the ala nasi. The aim of this study is to define the clinical characteristics of this scarring dystrophy, which we propose to call "early hypertrophy scarring", to clarify the nature thereof and to assess the efficacy of intralesional injection of corticosteroids at the first signs of hypertrophy.