Abstract
AIM—To describe a series of patients who have undergone a medial canthal reconstruction with a rhomboid flap. METHODS—A non-comparative interventional case series of 27 patients with medial canthal defects after Mohs excision of medial canthal basal cell carcinomas who underwent reconstruction using a rhomboid-shaped transpositional flap of adjoining skin and subcutaneous tissue. 25 cases were performed under local anaesthesia. The remaining two cases were combined with major lid reconstruction and performed under general anaesthesia. The outcome measures were closure of the defect, the cosmetic result, complications, and re-operations. RESULTS—Primary closure of the defect was achieved in all cases. The cosmetic result was highly satisfactory in all cases. There were no major complications or re-operations. Two cases had minor webbing of the medial upper lid. CONCLUSIONS—The rhomboid flap is an effective, quick, and simple technique for medial canthal reconstruction. It provides excellent cosmesis and is associated with minimal complications. It can be modified according to the nature of the periorbital skin and the location, size, and depth of the defect.
Full Text
The Full Text of this article is available as a PDF (163.4 KB).
Figure 1 .
Rhomboid flap. (A) Construction of the two possible rhomboid flaps oriented parallel to the lines of maximum extensibility (LME). (B) Defect is closed by transposing points A and B to A' and B'. (C) The upper flap closes the defect with the least distortion of surrounding tissues. (D) Resultant scar after suturing.
Figure 2 .
(a) Medial canthal defect extending into the lower lid with rhomboid flap marked. (b) Result 2 months postoperatively.
Figure 3 .
(a) Large medial canthal defect with rhomboid flap marked. (b) Minimal distortion of medial canthal tissues 3 months postoperatively.
Figure 4 .
(a) Large medial canthal defect requiring periosteal and rhomboid flaps. (b) Result 5 months postoperatively (separate eyelid margin basal cell carcinoma removed at a later date).
Figure 5 .
(a) Rhomboid flap for medial canthal defect in patient with thicker, sebaceous skin. (b) Result 9 months postoperatively.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Borges A. F. The rhombic flap. Plast Reconstr Surg. 1981 Apr;67(4):458–466. doi: 10.1097/00006534-198104000-00007. [DOI] [PubMed] [Google Scholar]
- Bullock J. D., Koss N., Flagg S. V. Rhomboid flap in ophthalmic plastic surgery. Arch Ophthalmol. 1973 Sep;90(3):203–205. doi: 10.1001/archopht.1973.01000050205005. [DOI] [PubMed] [Google Scholar]
- Harrington J. N. Reconstruction of the medial canthus by spontaneous granulation (Laissez-Faire): a review. Ann Ophthalmol. 1982 Oct;14(10):956-60, 963-6, 969-70. [PubMed] [Google Scholar]
- Inkster C., Ashworth J., Murdoch J. R., Montgomery P., Telfer N. R., Leatherbarrow B. Oculoplastic reconstruction following Mohs surgery. Eye (Lond) 1998;12(Pt 2):214–218. doi: 10.1038/eye.1998.51. [DOI] [PubMed] [Google Scholar]
- Patrinely J. R., Marines H. M., Anderson R. L. Skin flaps in periorbital reconstruction. Surv Ophthalmol. 1987 Jan-Feb;31(4):249–261. doi: 10.1016/0039-6257(87)90024-5. [DOI] [PubMed] [Google Scholar]
- Shotton F. T. Optimal closure of medial canthal surgical defects with rhomboid flaps: "rules of thumb" for flap and rhomboid defect orientations. Ophthalmic Surg. 1983 Jan;14(1):46–52. [PubMed] [Google Scholar]
- Sullivan T. J., Bray L. C. The bilobed flap in medial canthal reconstruction. Aust N Z J Ophthalmol. 1995 Feb;23(1):42–48. doi: 10.1111/j.1442-9071.1995.tb01644.x. [DOI] [PubMed] [Google Scholar]