From the Guidelines
A rhomboid flap is not recommended for the management of osteoradionecrosis (ORN) as the provided evidence does not support its use in this context. The evidence provided focuses on the management of ORN in patients with head and neck cancer treated with radiation therapy, and it recommends the use of vascularized tissue to cover larger defects, segmental maxillectomy or mandibulectomy with free flap reconstruction for full thickness ORN, and osteomyocutaneous free flap reconstructions for mandibular continuity defects 1.
When considering the use of a rhomboid flap, it is essential to evaluate the specific context and the type of defect being addressed. In general, a rhomboid flap can be used for closing skin defects in areas with limited tissue mobility, particularly on the back, scalp, and face, as it allows for the distribution of tension across the closure and can minimize visible scarring. However, the decision to use a rhomboid flap should be based on the individual patient's needs and the specific characteristics of the defect, taking into account factors such as tissue mobility, vascularity, and the potential for wound healing.
In the context of ORN management, the primary goal is to prevent further complications and promote healing, and the use of vascularized tissue and free flap reconstructions is generally preferred due to their ability to provide a reliable blood supply and support the healing process 1. Therefore, while a rhomboid flap may be a useful technique in certain situations, it is not the recommended approach for the management of ORN based on the provided evidence.
Key considerations for the use of a rhomboid flap include:
- The size and shape of the defect
- The availability of adjacent tissue with sufficient laxity
- The vascularity of the area
- The potential for wound healing and the risk of complications
- The cosmetic implications of the procedure. However, in the context of ORN, these considerations should be secondary to the primary goal of preventing further complications and promoting healing, and the use of vascularized tissue and free flap reconstructions should be prioritized 1.
From the Research
Indications for Rhomboid Flap
- Cutaneous defects resulting from trauma, infection, chronic illness, poor healing, or surgical resections can be reconstructed using a rhomboid flap 2
- The flap is suitable for defects of any size, caused by any etiology, and on any part of the body 2
- Rhomboid flaps can be used to reconstruct small to moderately sized skin defects 3
- The flap is a practical and efficient method of repairing small- to moderate-size surface defects of the head and neck 4
Advantages of Rhomboid Flap
- Provides excellent contour, texture, thickness, color match, long-term good cosmesis, and high patient satisfaction 2
- Quickly and easily designed, does not require any special instruments 2
- Can be safely used to reconstruct skin defects with no occurrences of partial or total flap necrosis or hematoma 3
- Combines the lateral shift and rotational methods of transfer, aiding in the closure of the donor site as the flap is transposed 4