Treatment of recontracture with the subcutaneous pedicle rhomboid flap

Treatment of recontractures that were previously skin grafted or treated with Z-plasty is a challenge. Application of a subsequent Z-plasty is risky because of the possibility of tip necrosis of the triangular flaps, whereas donor-site morbidity is undesirable if subsequent skin grafting is planned. The subcutaneous pedicle rhomboid flap is an effective technique for the treatment of every type of contracture. This article presents the clinical results of the rhomboid flap used in treatment of recontractures as an alternate technique to Z-plasty and skin grafting.

The authors operated on seven patients with recontractures (aged 4 to 45 years) using 19 rhomboid flaps. Flaps were applied in the upper extremity (seven flaps), lower extremity (five flaps), trunk (five flaps), neck (one flap), and axilla (one flap). Z-plasty scars were present in three locations, whereas skin grafting was previously applied in 16 locations. Preoperative rhomboid flap designs were made regardless of previous scars as single flaps in six locations and multiple flaps in 13 locations. Operations were performed under local and general anesthesia.

Patients were followed up for at least 6 months. All flaps achieved adequate relaxation postoperatively and healed uneventfully. The subcutaneous pedicle of the flap provided a distinct advantage in terms of vascularity. Recurrence was not seen in any of the patients.

The subcutaneous pedicle rhomboid flap is an effective and reliable technique for the treatment of recontractures. Preoperative planning is simple and independent of previous scars. Because the rhomboid flap resurfaces the emerged defects generated by relaxation incisions, one should consider that the flexibility of a single flap may not be adequate in some cases, and multiple flaps should be used.