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Subject: Rhomboid Flap
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Surgery tray instruments are listed in Appendix G. Consider adding skin hooks to gently handle the skin flaps. Have at least three fine (mosquito) hemostats to assist with hemostasis while developing large skin flaps.
Suggested suture removal times are listed in Appendix J, and a suggested anesthesia tray that can be used for this procedure is listed in Appendix F. All instruments can be ordered through local surgical supply houses.
Also see Appendix E: Skin Preparation Recommendations.
Closure of skin defects that have limited skin that matches the area to be removed
Closure of defects around eyes/eyebrows
Closure of defects on the lips
Closure of a defect over the glabella
Closure of a large hand defect
Closure of cheek defects
Practitioner’s unfamiliarity or inexperience with the techniques
Cellulitis in the tissues
Skin unable to be stretched to cover the defect
Chronic steroid use (and steroid skin effects)
PEARL: Consider using a permanent skin marker to mark the cut lines for the flap before the procedure, even if you do not normally need to mark flaps. The correct geometry of the rhomboid flap is critical to its success.
PEARL: When checking the geometry of the cuts, always release any tension being held on the skin, because it can distort the geometry.
PEARL: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
PITFALL: Do not excessively undermine the flap base, because this can compromise blood flow to the flap.
PITFALL: The skin may bunch up (i.e., make a dog ear) near the base of the flap. If it is significant, it is eliminated by excising triangular pieces of skin at a 120-degree angle (i.e., Burrow triangles).
Pain, infection, and bleeding
Nonunion of skin edges