Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Transposition Flaps Treatment & Management

  • Author: Vandana Chatrath, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jan 13, 2016
 

Intraoperative Details

Surgical approaches are described for the classic rhombic flap and for rhombic flap modifications.

Classic rhombic flap

The classic rhombic flap is constructed around a defect that is converted into a geometric 4-sided defect (rhombus) with equal side length and tip angles equal to 60° and 120°. It classically is designed by extending the short diameter of the defect (X) beyond the flap for a length equivalent to one of the sides (see image below).

Classic rhombic flap. Classic rhombic flap.

Then, the flap is created by drawing a line from the free end of the extended short diameter parallel to one of the sides of the existing rhombus (see image below).

Classic rhombic flap. Classic rhombic flap.

When designed in this manner, the tip angle is 60°. The flap typically is designed off the short axis of the defect to keep the flap as small as possible (see image below).

Classic rhombic flap. Classic rhombic flap.

A flap can be constructed in 4 possible directions for any rhomboid defect off its short axis (see image below). The optimal flap is chosen out of the 4 possibilities, keeping in mind the considerations outlined below.

Classic rhombic flap. Classic rhombic flap.

Best tension distribution

The flap uses the area of maximum tissue laxity with no effect on the surrounding anatomic structures when the flap is closed with no distortion of free margins (see image below).

Classic rhombic flap. Classic rhombic flap.

Best scar line

Orient the flap such that most of the resultant scar line lies along relaxed skin tension lines (see image below) or at the junction of 2 cosmetic units. In addition, if all else is equal, the scar should be placed in a lateral position.

Optimal placement. Optimal placement.

When patients look in a mirror and when they have face-to-face communication, a laterally placed scar is hidden much better than a medially placed scar (see images below).

Post-Mohs surgical defect over the left angle of t Post-Mohs surgical defect over the left angle of the mandible in a 63-year-old man.
Post-Mohs defect reconstructed with a classic rhom Post-Mohs defect reconstructed with a classic rhombic flap based superiorly and laterally.
Three months postreconstruction of the left angle Three months postreconstruction of the left angle of the mandible in a 63-year-old man.

Flap dynamics

The flap is designed (see section A of image below) and cut along the incision lines. It is undermined widely and rotated into the defect (see section B of image below). The secondary defect is closed with the first tension-bearing suture. However, even after the donor defect is closed, the flap is not completely tension free.

Classic rhombic flap. Classic rhombic flap.

Some shortening in the length of the flap occurs because of the restraint at the pivot point of the pedicle. Therefore, the leading flap tip does not quite meet the recipient tip. For the tips to meet, there must be some movement of the recipient tissue toward the flap and/or some degree of flap advancement (see section C of the image above). If this does not occur, the forceful pulling of the tip carries the risk of tip ischemia and necrosis. If no movement is possible in this direction, the flap may be oversized to compensate.

The classic rhombic flap has 2 major tension sites. The first and primary tension site is at the closure of the secondary defect, and the second site is at the closure of the leading tip. To ensure success of the flap, the surgeon must understand and plan for these tension forces. The tension may be minimized by the following modifications:

  • Lengthening the leading edge of the rhombic flap and elongating the secondary limb of the flap enlarges the flap while ensuring that the flap tip meets the recipient tissue without tension (see image below).
    Classic rhombic flap. Classic rhombic flap.
  • The leading tip may be made to reach the recipient tip in a tension-free environment if the flap angle is made slightly more obtuse, ie, greater than 120° (see image below).
    Classic rhombic flap. Classic rhombic flap.

Rhombic flap modifications

Webster flap[14]

In this modification of the rhombic flap, the tension is not fully displaced but rather shared by the lax adjacent tissue. It is designed by decreasing the flap tip angle to 30°, and the base of the flap is only half the length of the recipient defect (see image below).

Webster flap. Webster flap.

This narrows the flap pedicle and increases the side-to-side tension on the flap as the defect is closed. By doing so, the tension is shared between the area of the defect and the adjacent tissue where the flap is harvested. This additional tension, if too great, may increase the risk of flap ischemia or necrosis.

This flap most commonly is used when 2 flaps must draw from different tension vectors such that each flap closes one half of the defect, reducing the angle from 60° to 30°.

Dufourmentel flap[15]

This is a modification of the rhomboid transposition flap. The flap is designed by extending one line from the short axis to a length equivalent to the side lengths, similar to a classic rhombic flap, and another line is drawn by extending the side adjacent to the lower angle to a similar length (see image below).

Classic rhombic flap. Classic rhombic flap.

However, the incision is made along a line that bisects these 2 extended lines (see image below).

Classic rhombic flap. Classic rhombic flap.

A second incision is made along a line that is dropped from the end of the bisected line parallel to the long axis of the rhombic defect to complete the flap (see image below).

Classic rhombic flap. Classic rhombic flap.

By using a line drawn parallel to the long axis instead of one of the sides of the rhombic defect, the pedicle is widened but the movement is inhibited. Therefore, for the flap to rotate to its receptor angle completely, some degree of upward advancement is essential.

A key feature of the flap is the obtuseness of the leading angle. This relieves the pivotal restraint to some extent and results in more lateral tip tension compared to more vertical tip tension in a classic rhombic flap. Therefore, the Dufourmentel flap is useful in areas where lateral tension is acceptable and vertical pull is not.

Although this article deals with the construction of transposition flaps for rhomboid-shaped defects, the same principles may be used to reconstruct a circular defect. For this, the defect remains circular, and a rhombic design is drawn around it. With a circular defect, the flap may be designed in any direction, keeping in mind the optimal flexibility of the surrounding tissue and adjacent anatomic structures. The optimal closure lines are determined according to the resting skin tension lines or cosmetic unit junction lines and are transposed to the circular defect axis (the diameter of the circular wound). See image below.

Optimal placement of rhombic flaps. Optimal placement of rhombic flaps.

The length of the line extended beyond the defect is longer than the circular diameter because this diameter is shorter than the short axis of the rhomboid drawn around the circular defect. A second line of the same length is drawn, keeping a tip angle of 60° to complete the flap (see image above). The tissue redundancy created by the rotation of the transposition flap is removed with trimming of a triangle at the pivot point. The transposed tissue may be rounded to fit the circular defect, or the defect may be squared off to accommodate the angular flap. The surgeon may determine which of these modifications will yield the best aesthetic result.

Banner-type transposition flap

The finger-shaped flap is designed with a width that is equal to the width of the defect and a length equal to the distance from the pivot point to the far edge of the defect (see image below). The flap rotates in an arc about the pivot point. Although theoretically the flap can move through an arc of 180°, this is difficult to perform.

Banner transposition flap. Banner transposition flap.

Unless the flap is based on an artery, this movement of 180° may produce a kink at the base of a random pattern flap that decreases the perfusion of the tip. Therefore, the flap typically is designed to rotate through an angle of 60-120° (see image above). As the flap is rotated and transposed, a protrusion often forms at the base of the flap (see image below).

Banner transposition flap. Banner transposition flap.

This tissue redundancy (dog-ear) generated by the rotating motion should be removed. Care should be taken to remove the redundant tissue in a direction away from the pedicle of the flap such that the narrowing of the base of the flap does not compromise the blood flow to the flap, thereby affecting its viability (see images below).

Postoperative Mohs defect over the right ala and n Postoperative Mohs defect over the right ala and nasal sidewall in a 42-year-old man.
Reconstruction of the right alar and nasal sidewal Reconstruction of the right alar and nasal sidewall surgical defect with a nasolabial transposition flap (Banner).
Three months postrepair of the right alar and nasa 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 an Three months postrepair showing intact alar rim and patency of the nares.
Three months postrepair (front view) showing intac Three months postrepair (front view) showing intact symmetry of the nose a well-hidden scar within the cosmetic junction unit line (nasolabial fold).

Transposition island pedicle flap[16]

The design of the transposition island pedicle flap with a melolabial cheek donor site is such that a template is made of the defect and transposed onto the lower melolabial cheek. The distance between the lateral border of the defect and the template serves as the length of the island pedicle and should not be more than the defect width. If the length is longer, it impairs flap movement due to excess tissue at the point of transposition. The intervening skin between the flap and the template is excised partially, leaving a pedicle of subcutaneous tissue.

At the distal end of the flap, a full-thickness Burrow triangle is removed to facilitate closure of the donor area. Proximally, the pedicle is created, incorporating the subcutaneous tissue, deep muscle fibers, and vessel perforators to ensure flap survival through good vascular supply. The island flap is then transposed onto the defect by reflecting back the cheek skin at the point of transposition. The cheek skin is advanced medially and closed, eliminating the need to remove the proximal Burrow triangle.

For nasal sidewall and nasal ala defects, the sidewall acts as a donor site; the Burrow triangles are designed along the superior and inferolateral aspects of the defect. The island pedicle is created with the inclusion of the nasalis fibers to ensure vascularity. The secondary defect is closed by cheek advancement and primary closures of the Burrow triangles.

The major advantage of the transposition island pedicle flap is excellent color and texture match. The disadvantage, however, is the high incidence of trapdooring because, in these flaps, the proximal Burrow triangle is not excised and this may result in constriction of the surrounding flap causing the resultant trapdooring. This can be minimized to some extent by undermining the recipient site and placing tacking sutures if possible.

Subcutaneous pedicle Limberg flap[17, 18, 19]

This is an innovative refinement to the Limberg transposition flap that eliminates the dog ear and is useful in a variety of benign and malignant lesions of the face. The Limberg flap is designed near the defect with a 30-45°, and the width of the flap is approximately four fifths of the width of the defect. The distal part of the flap is elevated at the subcutaneous plane but over the mimetic muscle, and the proximal pedicle is then created as usual, incorporating the deep muscle fibers and vessel perforators.

A V-shaped incision limited to the immediate subdermis is performed at the pedicle of the flap, and this modification makes the Limberg flap a subcutaneous pedicle flap. The V-shaped incision is designed with a 45-60° angle so that this part of the donor site can also be sutured directly. In addition, further undermining around the V-shaped incision at the subdermal level, leaving the thick subcutaneous pedicle underneath, increases the mobility of the flap. This modified flap is of particular use in younger patients with restricted laxity of surrounding tissue.

Tunneled transposition flap[20]

This flap has 3 parts: (1) the inferior Burrow triangle, which is removed as a full-thickness, single-standing cone; (2) the donor site, which is to be completely matched to the primary defect; and (3) the superior Burrow triangle, which is excised to the dermis only because the underlying muscle and fat form the pedicle of the flap (see image below).

Tunneled transposition flap. Tunneled transposition flap.

As with all transposition flaps, ensuring that the flap and the pedicle are of appropriate length is important. Therefore, the distance from the tip of the superior Burrow triangle to the end of the donor site is 5 mm greater than the distance from the tip of the superior Burrow triangle to the end of the defect (see image above). If the flap is taken more superiorly from the melolabial fold, then the pedicle will twist as it tunnels into the defect and compromise the blood supply to the flap; additionally, if it is taken too inferiorly, then a bulge would develop in the flap owing to the increased length of the flap.

The first step in the execution of the flap is to remove the superior Burrow triangle up to the dermis. Then, the inferior Burrow triangle and the flap donor site are separated from the surrounding skin and lifted at the level of the subcutaneous fat. The pedicle is then dissected such that the pedicle consists of the deep subcutaneous fat and the muscle fiber of the levator labii superioris alaeque nasi. The proximal portion of the pedicle should be thicker than 3-4 mm to ensure a good blood supply to the flap, and the distal portion should be up to 3-4 mm and not more, because this is the part of the pedicle that passes through the tunnel of the melolabial fold and the alar crease.

Now, both the donor and recipient site of the flap should be extensively undermined, which allows the secondary defect to be closed easily and it creates the tunnel between the primary and secondary defects. After this, the flap and the pedicle pass through the tunnel that was created. Sometimes it may be necessary to remove some fat from the tunnel for the pedicle to pass more easily and without compression. The donor site is closed primarily along the melolabial fold, and the inferior Burrow triangle is trimmed so as to suture the flap into the defect. This enables a pleasing aesthetic outcome because the alar crease is completely preserved.

Next

Complications

Dehiscence

Primary dehiscence is due to incorrect construction of the flap such that there is excessive tension along the lines of closure. Secondary dehiscence is due to postoperative infection or bleeding (unrelated to the flap design or construction).

Flap necrosis

Flap necrosis may occur for a variety of reasons (eg, excessive tension, postoperative infection or bleeding, desiccation). Understanding the essential design and the pivotal restraining forces of transposition flaps is necessary to avoid problems. When the flap dynamics are understood and modifications are used to reduce tension on the tip, when required, complications are minimal.

Pincushioning, or the trapdoor phenomenon [21, 22]

This refers to the puffing up or out-pouching of a flap or graft above the surrounding skin surface and may occur in transposition flaps (see image below). It is seen more commonly with curvilinear flaps, such as the traditional banner and the double banner (bilobed) transposition flaps, because these allow more peripheral contraction than geometric flaps. Trapdooring also may occur because of such factors as excess subcutaneous fat under the flap, lymphedema (inferiorly based flaps offer better lymphatic drainage), oversized flaps, and a lack of contact inhibition (ie, failure to establish contact between the undersurface of the flap and the recipient bed), which allows contraction of the sides only and not the base, thereby pushing up the flap center.

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

The most important factor may be the process of scar contraction and maturation, which occurs at the periphery and base of the flap (see image below). If only the flap base contracts, the flap tissue is forced upward, creating pincushioning. The risk of puffing up or trapdooring can be minimized by avoiding the factors that may lead to it during the reconstruction of the flap.

Trapdoor phenomenon. Trapdoor phenomenon.

See the list below:

  • Use straight lines and geometric angles and avoid curvilinear lines wherever possible to minimize scar contraction.
  • Undermine widely beyond the base of the flap. This cannot be emphasized enough. Wide undermining creates a uniform plane of scar contraction and, therefore, does not push the flap tissue up.
  • Undersize the flap enough to prevent bunching up of the flap but not enough to cause tension on the line of closure because of the risk of flap necrosis.
  • Maintain contact of the flap base with the recipient base to cause contact inhibition of flap contraction. If necessary (eg, if covering a concavity), this may be facilitated by the use of an absorbable suture from the base of the flap to the recipient bed oriented parallel to the direction of the blood flow.
  • Orient or position the flap to allow good lymphatic drainage to prevent lymphedema. Inferiorly based flaps allow favorable lymphatic drainage.
  • Use Z-plasty at the base of a transposition flap, such as rhombic flap, to enhance flap mobility, especially on the nose to prevent nasal tip and alar rim distortion. [23]

Minor corrections can be made through intralesional steroid injections, but surgical debulking is needed for major trapdooring.

A study by Lindsay and Morton of 21 patients indicated that alar wounds left by excision of small, penetrating carcinomas can be successfully repaired, and pincushioning avoided, by combining a skin graft with a subcutaneous fat transposition flap from the adjacent cheek.[35]

Previous
Next

Outcome and Prognosis

In conclusion, many variations and modifications of transposition flaps exist. Similar to other flaps, transposition flaps may be further modified and adjusted to accommodate individual situations. They may be lengthened or shortened, and their angles may be altered depending upon the availability and laxity of surrounding skin.

Previous
Next

Future and Controversies

No single flap can be used to reconstruct all defects. Each patient must be treated with a unique strategy. A 2-dimensional picture of a given defect may seem to indicate a certain type of repair. This may or may not be the optimal repair for that given patient. Only by feeling the skin in the area around the defect may the best option for repair be determined.

Transposition flaps dissipate tension away from the flap apex and distribute it proximally, thus redirecting the tension lines and reducing the likelihood of anatomic distortion in the reconstructed area; this is a major advantage offered by the use of these types of flaps. Flaps designed in this manner allow improved contour by avoiding webbing, tenting across concavities, and bunching of skin laterally.

A significant degree of artistic ability and individual modification is required to consistently obtain optimal aesthetic and functional result.

Previous
 
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 Mohs and Reconstructive Surgery Surgery, SkinCare Physicians

Thomas Rohrer, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Received honoraria from CAndela / Syneron for speaking and teaching; Received grant/research funds from Merz for research; Received grant/research funds from Allergan for research.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Received grant/research funds from Genentech for investigator.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Desiree Ratner, MD Director, Comprehensive Skin Cancer Center, Continuum Cancer Centers of New York; Director of Dermatologic Surgery, Beth Israel Medical Center and St Luke's and Roosevelt Hospitals; Professor of Clinical Dermatology, Columbia University College of Physicians and Surgeons

Desiree Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

References
  1. Borges AF. The rhombic flap. Plast Reconstr Surg. 1981 Apr. 67(4):458-66. [Medline].

  2. Bray DA. Clinical applications of the rhomboid flap. Arch Otolaryngol. 1983 Jan. 109(1):37-42. [Medline].

  3. Fee WE Jr, Gunter JP, Carder HM. Rhomboid flap principles and common variations. Laryngoscope. 1976 Nov. 86(11):1706-11. [Medline].

  4. Larrabee WF Jr, Trachy R, Sutton D, Cox K. Rhomboid flap dynamics. Arch Otolaryngol. 1981 Dec. 107(12):755-7. [Medline].

  5. Masson JK, Mendelson BC. The banner flap. Am J Surg. 1977 Sep. 134(3):419-23. [Medline].

  6. Fortier-Riberdy G, Gloster HM. Reconstruction of the superior helical rim with a postauricular transposition flap. Dermatol Surg. 2005 Jan. 31(1):99-101. [Medline].

  7. Saleh DB, Tan J, Mohammed P, Majumder S. The lobular transposition flap - A useful adjunct to reconstruct helical defects. J Plast Reconstr Aesthet Surg. 2012 Jan 5. [Medline].

  8. Aasi SZ, Leffell DJ. Bilobed transposition flap. Dermatol Clin. 2005 Jan. 23(1):55-64, vi. [Medline].

  9. Cook JL. Reconstructive utility of the bilobed flap: lessons from flap successes and failures. Dermatol Surg. 2005 Aug. 31(8 Pt 2):1024-33. [Medline].

  10. McGregor JC, Soutar DS. A critical assessment of the bilobed flap. Br J Plast Surg. 1981 Apr. 34(2):197-205. [Medline].

  11. Morgan BL, Samiian MR. Advantages of the bilobed flap for closure of small defects of the face. Plast Reconstr Surg. 1973 Jul. 52(1):35-7. [Medline].

  12. Ricks M, Cook J. Extranasal applications of the bilobed flap. Dermatol Surg. 2005 Aug. 31(8 Pt 1):941-8. [Medline].

  13. Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. 1989 Jul. 125(7):957-9. [Medline].

  14. Webster RC, Davidson TM, Smith RC. The thirty degree transposition flap. Laryngoscope. 1978 Jan. 88(1 Pt 1):85-94. [Medline].

  15. Lister GD, Gibson T. Closure of rhomboid skin defects: the flaps of Limberg and Dufourmentel. Br J Plast Surg. 1972 Jul. 25(3):300-14. [Medline].

  16. Hairston BR, Nguyen TH. Innovations in the island pedicle flap for cutaneous facial reconstruction. Dermatol Surg. 2003 Apr. 29(4):378-85. [Medline].

  17. Borges AF. Choosing the correct Limberg flap. Plast Reconstr Surg. 1978 Oct. 62(4):542-5. [Medline].

  18. Brobyn TJ, Cramer LM, Hulnick SJ, Kodsi MS. Facial resurfacing with the Limberg flap. Clin Plast Surg. 1976 Jul. 3(3):481-90. [Medline].

  19. Jun-Hui L, Xin X, Tian-Xiang O. Subcutaneous Pedicle Limberg Flap for Facial Reconstruction. Dermatol Surg. 2005. 31:949-952.

  20. Krishnan RS, Clark DP, Donnelly HB. Tunneled transposition flap for reconstruction of defects of the nasal ala. Dermatol Surg. 2007 Dec. 33(12):1496-501. [Medline].

  21. Koranda FC, Webster RC. Trapdoor effect in nasolabial flaps. Causes and corrections. Arch Otolaryngol. 1985 Jul. 111(7):421-4. [Medline].

  22. Webster RC, Benjamin BJ, Smith RC. Treatment of "trap door deformity.". Laryngoscope. 1978 Apr. 88(4):707-12. [Medline].

  23. 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.

  24. Bauer BS, Margulis A. The expanded transposition flap: shifting paradigms based on experience gained from two decades of pediatric tissue expansion. Plast Reconstr Surg. 2004 Jul. 114(1):98-106. [Medline].

  25. Converse JM, ed. Reconstructive Plastic Surgery: General Principles. 2nd ed. Philadelphia, Pa: WB Saunders; 1977. 202-7.

  26. 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.

  27. Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol. 1987 Dec. 13(12):1348-53. [Medline].

  28. Grabb WC, Myers MB, eds. Skin Flaps. Boston, Mass: Little Brown & Company; 1975. 111-31.

  29. Limberg AA. Design of local flaps. Gibson T, ed. Modern Trends of Plastic Surgery. London, England: Butterworth-Heinemann; 1966. 38-61.

  30. Rohrer TE, Bhatia A. Transposition flaps in cutaneous surgery. Dermatol Surg. 2005 Aug. 31(8 Pt 2):1014-23. [Medline].

  31. Rossi A, Jeffs JV. The rhomboid flap of Limberg--a simple aid to planning. Ann Plast Surg. 1980 Dec. 5(6):494-6. [Medline].

  32. Webster RC, Benjamin BJ, Smith RC. Closure of circular defects. Laryngoscope. 1978 Mar. 88(3):534-8. [Medline].

  33. Yanai A, Ueda K, Takato T. Flexible rhombic flap. Plast Reconstr Surg. 1986 Aug. 78(2):228-35. [Medline].

  34. 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. 2001 May. 107(6):1358-62. [Medline].

  35. Lindsay KJ, Morton JD. Flap or graft: The best of both in nasal ala reconstruction. J Plast Reconstr Aesthet Surg. 2015 Oct. 68 (10):1352-7. [Medline].

  36. Topp SG, Lovald S, Khraishi T, Gaball CW. Biomechanics of the rhombic transposition flap. Otolaryngol Head Neck Surg. 2014 Dec. 151 (6):952-9. [Medline].

 
Previous
Next
 
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.
Three months postreconstruction of the left angle of the mandible in a 63-year-old man.
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 transposition flap.
Tunneled transposition flap.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.