Versatile rhomboid flaps in paediatric surgical practice

Abstract

Background: Tension-free closure of large cutaneous defects after excision of primary pathology poses a challenge to the operating surgeon. The objective of the study was to review the use of rhomboid flaps (RFs) in the closure of surgical defects at different locations and of varying pathology. Materials and Methods: A retrospective study on all cases of surgical wounds closed with RFs from January 2014 to December 2019 was conducted in the department of pediatric surgery at a tertiary care center. Data regarding the demographic details of the patient, location of the wound with its shape and size, details of the primary lesion, and any postoperative complications were noted and analyzed. Results: RFs were used in 73 large defects with the ratio of transverse to longitudinal dimensions ranging between 0.67 and 1.49. These defects had variable pathology and different location (59 - neural tube defects; 9 - arteriovenous malformation; 2 - amniotic bands; 2-pilonidal sinus; and 1 - coccydynia with ulcer). Different modifications of RFs included variation in the direction towards which they were raised, multiplicity of the flaps, variation in the angle at which the flap was fashioned (Dufourmentel modification), and lessening the flap length to match the short diagonal of the wound (Quaba modification). Minimal complication in the form of wound infection (5/73), dehiscence at the tip of the flap (2/73), and hematoma (3/73) was observed which were managed conservatively. Conclusion: Versatile and universal RFs offer tension-free closure of large wounds at different anatomical locations with minimal complication and are indispensable tools in the hands of a pediatric surgeon.

Keywords

• modification
• rhomboid flaps
• wound closure