Closure of rhomboid skin defects: the flaps of Limberg and Dufourmentel.

IN excising the majority of skin lesions, surgeons create an elliptical can be closed directly. As the lesions increase in size, however, there comes when either the long axis of the ellipse becomes too long for the local cosmetic result, or the short axis too wide to permit direct suture. In instances the excisional outline may be replanned and closure obtained with flap, until of course the defect becomes so large that cover can only be imported skin. Designing such local flaps, particularly when the secondary defect is to directly, can tax the skill of the most experienced plastic surgeon. Only trial and error does he learn intuitively to judge the maximum tension under can suture the pardy devascularised flap and the absolute limits to which stretch the surrounding skin ; the art of designing such flaps takes long to is hard to teach. There are, however, 2 exceptions to which we would like to draw the flaps designed by Limberg (I 946, 1966, and 1967) and by Dufourmentel to close rhomboid defects. A rhombus is an equilateral parallelogram and regarded as an" ellipse with straight sides .". Rhomboid excision has so over elliptical excision particularly when the defect is to be closed with a For example, less normal skin needs to be excised in the long axis, the design and of a straight-sided flap is far simpler than that of the round flap and rhomboid lends itself to the technique recommended by Borghouts (1964) of histological lion of the specimen margins to check mmour clearance. The Limberg flap and the Dufourmentel flap are different in design and and will be described and discussed separately.