Modified rhombic flap for closure of circular or irregular defects

Rhombic flaps include the Limberg and the Quaba/Sommerlad flaps. The latter was described as successful placement of "a square peg in a round hole" but reported a 22% incidence of dog-ear formation complicating the postoperative course of surgery.

To demonstrate the clinical use and compare and contrast the rationale of a modified rhombic flap for closure of wounds of circular or irregular shape that aims to minimize dog-ear formation.

This closure is essentially a 60 degrees transposition flap applied to a round or irregularly shaped defect. The flap is made slightly smaller than the defect. A modification of the Quaba/Sommerlad flap was made whereby a standing-cone was removed from the hinge-point of the base of the flap during the procedure and a greater flap size was used. A series of 104 cases was assessed by photographic and clinical record perioperatively and at 6 months of postoperative follow-up.

No dog-ear formation was found in any of the cases. Other complications were minimal. This flap has been found to be simple to design, and also practical with a wide variety of wound shapes and anatomic sites successfully closed.

This modification successfully eliminates the most common complication of the Quaba/Sommerlad flap. The modified rhombic flap is a very versatile, safe method, of wound repair and is particularly well suited to Mohs' excision surgery.