The use of subcutaneous pedicle multiple rhomboid flaps in the treatment of long postburn scar contractures

The subcutaneous pedicle rhomboid flap is a relatively new technique in the treatment of linear, wide or quadratic postburn scar contractures with two or more contracture lines. The effectiveness of the rhomboid flap depends on lengthening the contracture band by relaxation incisions and closing the emerged defect by suturing the rhomboid flap in V-Y and Y-V advancement. The technique is simple, efficient and versatile. The broad subcutaneous pedicle of the flap is very reliable and postoperative flap necrosis is rare. Clinical results show that the gain in length provided by a single rhomboid flap ranges from 75-90%. However, the technique may not be efficient enough to release the whole band in cases of long contracture bands. Therefore, a new design of rhomboid flaps, called "multiple rhomboid flaps", may be needed. Twelve patients (aged 3-40 years) with long linear and wide scar contractures were successfully treated with subcutaneous pedicle multiple rhomboid flaps. Multiple consequent or adjacent rhomboid flaps were applied in the upper extremity (in nine patients), trunk (in seven patients), and lower extremity (in two patients). Complete relaxation and elongation of the contracture bands were achieved in all of the cases and all rhomboid flaps healed uneventfully. The results were functionally and cosmetically successful. The application of rhomboid flaps in this consequent and adjacent fashion is a new concept. Clinical results prove that the technique is versatile and effective in the release of long potstburn scar contractures. Since distortion of the surrounding skin or displacement of anatomical landmarks is not seen with the technique, color and texture matches are perfect. Designing and performing multiple rhomboid flaps is very simple and the operation time is short. As no undermining is carried out in the technique, the flaps are more reliable than commonly used multiple Z-plasty.