eMedicine Specialties > Dermatology > Surgical

Transposition Flaps: Multimedia

Author: Vandana Chatrath, MD, Consultant in Dermatology, Delhi Dermatology Group, India
Coauthor(s): Thomas Rohrer, MD, Director of Dermatologic Surgery, Associate Professor; Department of Dermatology, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Feb 26, 2009

Multimedia

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Media file 1: Transposition flaps.

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Transposition flaps.

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Media file 2: Reservoirs of extra skin.

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Reservoirs of extra skin.

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Media file 3: Transposition flaps.

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Transposition flaps.

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Media file 4: Classic rhombic flap.

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Classic rhombic flap.

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Media file 5: Classic rhombic flap.

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Classic rhombic flap.

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Media file 6: Classic rhombic flap.

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Classic rhombic flap.

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Media file 7: Classic rhombic flap.

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Classic rhombic flap.

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Media file 8: Classic rhombic flap.

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Classic rhombic flap.

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Media file 9: Optimal placement.

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Optimal placement.

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Media file 10: Post-Mohs surgical defect over the left angle of the mandible in a 63-year-old man.

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Post-Mohs surgical defect over the left angle of the mandible in a 63-year-old man.

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Media file 11: Post-Mohs defect reconstructed with a classic rhombic flap based superiorly and laterally.

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Post-Mohs defect reconstructed with a classic rhombic flap based superiorly and laterally.

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Media file 12: Same patient as in Media File 10, 3 months postreconstruction of the left angle of the mandible.

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Same patient as in Media File 10, 3 months postreconstruction of the left angle of the mandible.

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Media file 13: Classic rhombic flap.

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Classic rhombic flap.

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Media file 14: Classic rhombic flap.

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Classic rhombic flap.

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Media file 15: Classic rhombic flap.

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Classic rhombic flap.

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Media file 16: Webster flap.

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Webster flap.

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Media file 17: Classic rhombic flap.

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Classic rhombic flap.

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Media file 18: Classic rhombic flap.

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Classic rhombic flap.

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Media file 19: Classic rhombic flap.

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Classic rhombic flap.

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Media file 20: Optimal placement of rhombic flaps.

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Optimal placement of rhombic flaps.

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Media file 21: Rhombic flap uses.

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Rhombic flap uses.

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Media file 22: Post-Mohs surgical defect over the right nasal sidewall in a 38-year-old woman.

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Post-Mohs surgical defect over the right nasal sidewall in a 38-year-old woman.

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Media file 23: Reconstruction of the right nasal sidewall defect with a superiorly based Dufourmentel flap.

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Reconstruction of the right nasal sidewall defect with a superiorly based Dufourmentel flap.

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Media file 24: Side view of the nose, 3 months postreconstruction of the right nasal sidewall defect.

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Side view of the nose, 3 months postreconstruction of the right nasal sidewall defect.

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Media file 25: Front view of the nose with no distortion of the structure and maintenance of the nasal symmetry.

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Front view of the nose with no distortion of the structure and maintenance of the nasal symmetry.

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Media file 26: Postoperative Mohs defect on the right cheek of a 69-year-old man.

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Postoperative Mohs defect on the right cheek of a 69-year-old man.

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Media file 27: Reconstruction of the right cheek defect with a superiorly and laterally based Dufourmentel flap.

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Reconstruction of the right cheek defect with a superiorly and laterally based Dufourmentel flap.

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Media file 28: One-week postrepair of the right cheek defect with the resultant scar placed laterally to make it less noticeable.

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One-week postrepair of the right cheek defect with the resultant scar placed laterally to make it less noticeable.

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Media file 29: Three months postreconstruction of the right cheek defect with the Dufourmentel flap.

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Three months postreconstruction of the right cheek defect with the Dufourmentel flap.

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Media file 30: Postoperative Mohs defect over the left inferior angle of the mouth in a 60-year-old man.

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Postoperative Mohs defect over the left inferior angle of the mouth in a 60-year-old man.

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Media file 31: Reconstruction of the surgical defect with a superiorly based Dufourmentel flap to prevent distortion of the lower lip.

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Reconstruction of the surgical defect with a superiorly based Dufourmentel flap to prevent distortion of the lower lip.

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Media file 32: Three months postrepair of the left inferior angle of the mouth defect with the Dufourmentel flap (close-up view).

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Three months postrepair of the left inferior angle of the mouth defect with the Dufourmentel flap (close-up view).

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Media file 33: Three months postrepair of the left inferior angle of the mouth (front view).

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Three months postrepair of the left inferior angle of the mouth (front view).

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Media file 34: Postoperative Mohs surgical defect over the left chin in a 74-year-old woman.

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Postoperative Mohs surgical defect over the left chin in a 74-year-old woman.

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Media file 35: Reconstruction of the surgical defect with an inferiorly and medially based Dufourmentel flap.

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Reconstruction of the surgical defect with an inferiorly and medially based Dufourmentel flap.

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Media file 36: Three months postrepair of the left chin surgical defect with the resultant scar hidden well in the submental crease.

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Three months postrepair of the left chin surgical defect with the resultant scar hidden well in the submental crease.

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Media file 37: Three months postrepair (front view) of the left chin defect with no distortion of the neighboring anatomic structures and maintenance of symmetry.

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Three months postrepair (front view) of the left chin defect with no distortion of the neighboring anatomic structures and maintenance of symmetry.

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Media file 38: Postoperative Mohs defect in the right concha of a 58-year-old man.

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Postoperative Mohs defect in the right concha of a 58-year-old man.

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Media file 39: Reconstruction of the right conchal surgical defect with a Banner transposition flap.

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Reconstruction of the right conchal surgical defect with a Banner transposition flap.

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Media file 40: Three months postrepair of the right conchal surgical defect with no distortion of the structure of the ear.

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Three months postrepair of the right conchal surgical defect with no distortion of the structure of the ear.

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Media file 41: Three months postrepair of the right conchal surgical defect (close-up view).

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Three months postrepair of the right conchal surgical defect (close-up view).

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Media file 42: Banner transposition flap.

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Banner transposition flap.

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Media file 43: Banner transposition flap.

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Banner transposition flap.

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Media file 44: Postoperative Mohs defect over the right ala and nasal sidewall in a 42-year-old man.

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Postoperative Mohs defect over the right ala and nasal sidewall in a 42-year-old man.

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Media file 45: Reconstruction of the right alar and nasal sidewall surgical defect with a nasolabial transposition flap (Banner).

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Reconstruction of the right alar and nasal sidewall surgical defect with a nasolabial transposition flap (Banner).

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Media file 46: Three months postrepair of the right alar and nasal sidewall defect with the Banner transposition flap (side view).

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Three months postrepair of the right alar and nasal sidewall defect with the Banner transposition flap (side view).

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Media file 47: Three months postrepair showing intact alar rim and patency of the nares.

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Three months postrepair showing intact alar rim and patency of the nares.

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Media file 48: Three months postrepair (front view) showing intact symmetry of the nose a well-hidden scar within the cosmetic junction unit line (nasolabial fold).

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Three months postrepair (front view) showing intact symmetry of the nose a well-hidden scar within the cosmetic junction unit line (nasolabial fold).

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Media file 49: Bilobed flap.

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Bilobed flap.

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Media file 50: Bilobed flap evolution.

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Bilobed flap evolution.

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Media file 51: Bilobed flap modification.

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Bilobed flap modification.

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Media file 52: Post-Mohs surgical defect over the right nasal sidewall in a 66-year-old man.

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Post-Mohs surgical defect over the right nasal sidewall in a 66-year-old man.

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Media file 53: Reconstruction of the left nasal sidewall surgical defect with a bilobed flap (Zitelli modification).

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Reconstruction of the left nasal sidewall surgical defect with a bilobed flap (Zitelli modification).

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Media file 54: Bilobed flap modification.

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Bilobed flap modification.

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Media file 55: Bilobed flap with the first and second lobe covering the primary and secondary defect respectively after side-to-side closure of the tertiary defect.

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Bilobed flap with the first and second lobe covering the primary and secondary defect respectively after side-to-side closure of the tertiary defect.

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Media file 56: Completed bilobed flap for reconstruction of the left nasal sidewall defect with no distortion of the ala.

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Completed bilobed flap for reconstruction of the left nasal sidewall defect with no distortion of the ala.

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Media file 57: Anatomic areas where a bilobed flap may be used.

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Anatomic areas where a bilobed flap may be used.

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Media file 58: Postoperative Mohs defect over the left tip of the nose in a 71-year-old man.

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Postoperative Mohs defect over the left tip of the nose in a 71-year-old man.

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Media file 59: Reconstruction of the left nasal tip surgical defect with a bilobed flap to provide a good texture and color match.

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Reconstruction of the left nasal tip surgical defect with a bilobed flap to provide a good texture and color match.

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Media file 60: Three months postrepair of the left nasal tip.

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Three months postrepair of the left nasal tip.

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Media file 61: Three months post repair (front view) with no distortion of the tip.

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Three months post repair (front view) with no distortion of the tip.

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Media file 62: Three months postrepair with a well-blended scar line (side view).

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Three months postrepair with a well-blended scar line (side view).

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Media file 63: Postoperative Mohs defect over the left nasal sidewall in a 45-year-old woman with a bilobed transposition flap marked for repair.

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Postoperative Mohs defect over the left nasal sidewall in a 45-year-old woman with a bilobed transposition flap marked for repair.

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Media file 64: Three months postreconstruction of the surgical defect over the left nasal sidewall with a bilobed transposition flap

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Three months postreconstruction of the surgical defect over the left nasal sidewall with a bilobed transposition flap

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Media file 65: Postoperative Mohs defect over the helix of the right ear in a 59-year-old man.

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Postoperative Mohs defect over the helix of the right ear in a 59-year-old man.

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Media file 66: Reconstruction of the right helical surgical defect with a bilobed flap exploiting the laxity of the postauricular skin.

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Reconstruction of the right helical surgical defect with a bilobed flap exploiting the laxity of the postauricular skin.

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Media file 67: Three months postrepair of the right helical surgical defect with the bilobed flap.

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Three months postrepair of the right helical surgical defect with the bilobed flap.

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Media file 68: Three months postrepair of the right helical surgical defect showing intact helical rim with no distortion of the structure of the ear.

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Three months postrepair of the right helical surgical defect showing intact helical rim with no distortion of the structure of the ear.

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Media file 69: Transposition flap used for the reconstruction of a Mohs defect over the left ala showing trapdooring (puffing up) of the flap.

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Transposition flap used for the reconstruction of a Mohs defect over the left ala showing trapdooring (puffing up) of the flap.

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Media file 70: Trapdoor phenomenon.

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Trapdoor phenomenon.

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Media file 71: Tunneled transition flap.

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Tunneled transition flap.

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Media file 72: Tunneled transition flap.

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Tunneled transition flap.

More on Transposition Flaps

Overview: Transposition Flaps

Treatment: Transposition Flaps

Follow-up: Transposition Flaps

Multimedia: Transposition Flaps

References

« Previous Page

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References

Borges AF. The rhombic flap. Plast Reconstr Surg. Apr 1981;67(4):458-66. [Medline].
Bray DA. Clinical applications of the rhomboid flap. Arch Otolaryngol. Jan 1983;109(1):37-42. [Medline].
Fee WE Jr, Gunter JP, Carder HM. Rhomboid flap principles and common variations. Laryngoscope. Nov 1976;86(11):1706-11. [Medline].
Larrabee WF Jr, Trachy R, Sutton D, Cox K. Rhomboid flap dynamics. Arch Otolaryngol. Dec 1981;107(12):755-7. [Medline].
Masson JK, Mendelson BC. The banner flap. Am J Surg. Sep 1977;134(3):419-23. [Medline].
Fortier-Riberdy G, Gloster HM. Reconstruction of the superior helical rim with a postauricular transposition flap. Dermatol Surg. Jan 2005;31(1):99-101. [Medline].
Aasi SZ, Leffell DJ. Bilobed transposition flap. Dermatol Clin. Jan 2005;23(1):55-64, vi. [Medline].
Cook JL. Reconstructive utility of the bilobed flap: lessons from flap successes and failures. Dermatol Surg. Aug 2005;31(8 Pt 2):1024-33. [Medline].
McGregor JC, Soutar DS. A critical assessment of the bilobed flap. Br J Plast Surg. Apr 1981;34(2):197-205. [Medline].
Morgan BL, Samiian MR. Advantages of the bilobed flap for closure of small defects of the face. Plast Reconstr Surg. Jul 1973;52(1):35-7. [Medline].
Ricks M, Cook J. Extranasal applications of the bilobed flap. Dermatol Surg. Aug 2005;31(8 Pt 1):941-8. [Medline].
Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. Jul 1989;125(7):957-9. [Medline].
Webster RC, Davidson TM, Smith RC. The thirty degree transposition flap. Laryngoscope. Jan 1978;88(1 Pt 1):85-94. [Medline].
Lister GD, Gibson T. Closure of rhomboid skin defects: the flaps of Limberg and Dufourmentel. Br J Plast Surg. Jul 1972;25(3):300-14. [Medline].
Hairston BR, Nguyen TH. Innovations in the island pedicle flap for cutaneous facial reconstruction. Dermatol Surg. Apr 2003;29(4):378-85. [Medline].
Borges AF. Choosing the correct Limberg flap. Plast Reconstr Surg. Oct 1978;62(4):542-5. [Medline].
Brobyn TJ, Cramer LM, Hulnick SJ, Kodsi MS. Facial resurfacing with the Limberg flap. Clin Plast Surg. Jul 1976;3(3):481-90. [Medline].
Jun-Hui L, Xin X, Tian-Xiang O. Subcutaneous Pedicle Limberg Flap for Facial Reconstruction. Dermatol Surg. 2005;31:949-952.
Koranda FC, Webster RC. Trapdoor effect in nasolabial flaps. Causes and corrections. Arch Otolaryngol. Jul 1985;111(7):421-4. [Medline].
Webster RC, Benjamin BJ, Smith RC. Treatment of "trap door deformity.". Laryngoscope. Apr 1978;88(4):707-12. [Medline].
Rotunda AM, Bennett RG. Nasal tip wound repair using a rhombic transposition flap with a double Z-plasty at its base. Dermatol Surg. 2006;32:945-947.
Bauer BS, Margulis A. The expanded transposition flap: shifting paradigms based on experience gained from two decades of pediatric tissue expansion. Plast Reconstr Surg. Jul 2004;114(1):98-106. [Medline].
Converse JM, ed. Reconstructive Plastic Surgery: General Principles. 2^nd ed. Philadelphia, Pa: WB Saunders; 1977:202-7.
Davidson TM, Webster RC, Gordon BR. The Principles and Dynamics of Local Skin Flaps. Chicago, Ill: American Academy of Otolaryngology Head and Neck Surgery; 1983.
Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol. Dec 1987;13(12):1348-53. [Medline].
Grabb WC, Myers MB, eds. Skin Flaps. Boston, Mass: Little Brown & Company; 1975:111-31.
Krishnan RS, Clark DP, Donnelly HB. Tunneled transposition flap for reconstruction of defects of the nasal ala. Dermatol Surg. Dec 2007;33(12):1496-501. [Medline].
Limberg AA. Design of local flaps. In: Gibson T, ed. Modern Trends of Plastic Surgery. London, England: Butterworth-Heinemann; 1966:38-61.
Rohrer TE, Bhatia A. Transposition flaps in cutaneous surgery. Dermatol Surg. Aug 2005;31(8 Pt 2):1014-23. [Medline].
Rossi A, Jeffs JV. The rhomboid flap of Limberg--a simple aid to planning. Ann Plast Surg. Dec 1980;5(6):494-6. [Medline].
Webster RC, Benjamin BJ, Smith RC. Closure of circular defects. Laryngoscope. Mar 1978;88(3):534-8. [Medline].
Yanai A, Ueda K, Takato T. Flexible rhombic flap. Plast Reconstr Surg. Aug 1986;78(2):228-35. [Medline].
Yotsuyanagi T, Yamashita K, Urushidate S, et al. Reconstruction of large nasal defects with a combination of local flaps based on the aesthetic subunit principle. Plast Reconstr Surg. May 2001;107(6):1358-62. [Medline].

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Keywords

transposition flaps, facial reconstruction, repairing defects with transposition flaps, bilobed flaps, rhombic flaps, rhomboid flaps, Dufourmentel flaps, banner-type flaps, nasolabial transposition flaps, island pedicle flaps, transposition island pedicle flaps, Webster flaps

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Contributor Information and Disclosures

Author

Vandana Chatrath, MD, Consultant in Dermatology, Delhi Dermatology Group, India
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Rohrer, MD, Director of Dermatologic Surgery, Associate Professor; Department of Dermatology, Boston University School of Medicine
Thomas Rohrer, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

Medical Editor

Désirée Ratner, MD, Director of Dermatologic Surgery, Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center, New York Presbyterian Hospital
Désirée Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME accredited Fellowship in Procedural Dermatology
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Search for CME/CE on This Topic »

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eMedicine Specialties > Dermatology > Surgical

Transposition Flaps: Multimedia

Multimedia

Transposition flaps.

Reservoirs of extra skin.

Transposition flaps.

Classic rhombic flap.

Classic rhombic flap.

Classic rhombic flap.

Classic rhombic flap.

Classic rhombic flap.

Optimal placement.

Post-Mohs surgical defect over the left angle of the mandible in a 63-year-old man.

Post-Mohs defect reconstructed with a classic rhombic flap based superiorly and laterally.

Same patient as in Media File 10, 3 months postreconstruction of the left angle of the mandible.

Classic rhombic flap.

Classic rhombic flap.

Classic rhombic flap.

Webster flap.

Classic rhombic flap.

Classic rhombic flap.

Classic rhombic flap.

Optimal placement of rhombic flaps.

Rhombic flap uses.

Post-Mohs surgical defect over the right nasal sidewall in a 38-year-old woman.

Reconstruction of the right nasal sidewall defect with a superiorly based Dufourmentel flap.

Side view of the nose, 3 months postreconstruction of the right nasal sidewall defect.

Front view of the nose with no distortion of the structure and maintenance of the nasal symmetry.

Postoperative Mohs defect on the right cheek of a 69-year-old man.

Reconstruction of the right cheek defect with a superiorly and laterally based Dufourmentel flap.

One-week postrepair of the right cheek defect with the resultant scar placed laterally to make it less noticeable.

Three months postreconstruction of the right cheek defect with the Dufourmentel flap.

Postoperative Mohs defect over the left inferior angle of the mouth in a 60-year-old man.

Reconstruction of the surgical defect with a superiorly based Dufourmentel flap to prevent distortion of the lower lip.

Three months postrepair of the left inferior angle of the mouth defect with the Dufourmentel flap (close-up view).

Three months postrepair of the left inferior angle of the mouth (front view).

Postoperative Mohs surgical defect over the left chin in a 74-year-old woman.

Reconstruction of the surgical defect with an inferiorly and medially based Dufourmentel flap.

Three months postrepair of the left chin surgical defect with the resultant scar hidden well in the submental crease.

Three months postrepair (front view) of the left chin defect with no distortion of the neighboring anatomic structures and maintenance of symmetry.

Postoperative Mohs defect in the right concha of a 58-year-old man.

Reconstruction of the right conchal surgical defect with a Banner transposition flap.

Three months postrepair of the right conchal surgical defect with no distortion of the structure of the ear.

Three months postrepair of the right conchal surgical defect (close-up view).

Banner transposition flap.

Banner transposition flap.

Postoperative Mohs defect over the right ala and nasal sidewall in a 42-year-old man.

Reconstruction of the right alar and nasal sidewall surgical defect with a nasolabial transposition flap (Banner).

Three months postrepair of the right alar and nasal sidewall defect with the Banner transposition flap (side view).

Three months postrepair showing intact alar rim and patency of the nares.

Three months postrepair (front view) showing intact symmetry of the nose a well-hidden scar within the cosmetic junction unit line (nasolabial fold).

Bilobed flap.

Bilobed flap evolution.

Bilobed flap modification.

Post-Mohs surgical defect over the right nasal sidewall in a 66-year-old man.

Reconstruction of the left nasal sidewall surgical defect with a bilobed flap (Zitelli modification).

Bilobed flap modification.

Bilobed flap with the first and second lobe covering the primary and secondary defect respectively after side-to-side closure of the tertiary defect.

Completed bilobed flap for reconstruction of the left nasal sidewall defect with no distortion of the ala.

Anatomic areas where a bilobed flap may be used.

Postoperative Mohs defect over the left tip of the nose in a 71-year-old man.

Reconstruction of the left nasal tip surgical defect with a bilobed flap to provide a good texture and color match.

Three months postrepair of the left nasal tip.

Three months post repair (front view) with no distortion of the tip.

Three months postrepair with a well-blended scar line (side view).

Postoperative Mohs defect over the left nasal sidewall in a 45-year-old woman with a bilobed transposition flap marked for repair.

Three months postreconstruction of the surgical defect over the left nasal sidewall with a bilobed transposition flap

Postoperative Mohs defect over the helix of the right ear in a 59-year-old man.

Reconstruction of the right helical surgical defect with a bilobed flap exploiting the laxity of the postauricular skin.

Three months postrepair of the right helical surgical defect with the bilobed flap.

Three months postrepair of the right helical surgical defect showing intact helical rim with no distortion of the structure of the ear.

Transposition flap used for the reconstruction of a Mohs defect over the left ala showing trapdooring (puffing up) of the flap.

Trapdoor phenomenon.

Tunneled transition flap.

Tunneled transition flap.

More on Transposition Flaps

References

Further Reading

Keywords

Contributor Information and Disclosures