Editing Skin flap techniques (section)

== Rhomboid (Limberg) flap ==

* Most useful where tension is in the wrong direction. Good for forehead, temple, scalp
* Since length:breadth <1, can be designed without regard for blood supply
* Ideally, internal angles of 60 and 120 degrees, but can vary this somewhat. Lengths of all four sides should be equal.
* A-G should continue the line of the short axis A-D, with both the same length
* B-G should be parallel to E-A
* Direction the skin comes from is determined by the availability of skin
* Ensure the donor site is able to be closed. If that is ok, the flap should be fine.
* If the closure is likely to be tight, can leave the little triangles of skin near point C and point D, as long as it doesn't compromise margins
* There is always a dog ear at E, which should generally be removed
* Undermining must go right to the base of the flap (E-B) or it won't mobilise enough
* Check haemostasis of donor site, underside of the flap and the defect prior to suturing
* Closure
** Start with a suture to AB, allowing the flap to fall into the defect
** Then close CD, the tightest point (if it won't close, may need more undermining, or closing the looser parts first to progressively pull the flap across)
** Then close the rest