A Case Scenario

Dr Nasir
Surgical Registrar
University of Lahore Teaching Hospital
Lahore
24 Y old Male
Recurrent Pilonidal Sinus X 3
Rhomboid Flap Cut and
Transposed
End Result
PRESENTATION PART 2
 Rhomboid Flap - A useful skill for
the surgical postgraduates to learn

Professor Muhammad Arshad Cheema FRCS

Chairman Department of Surgery
University of Lahore
Local Flaps in
Reconstruction
• V - Y advancement
• Local Rotation
• Transposition
• Z Plasty etc

• Rhomboid (or Limberg) is

a specialized form of
transposition flap with all
sides equal
 Rhomboid (Limberg) Flap
• Defect cut into a
rhomboid shape
• 60 & 120 degree
angles
• Loose skin has to be
present on the side
from where flap is
raised
• Theoretically 8 flaps
can be raised on 4
sides of a rhomboid
• All sides of flap and
defect are equal
• Closure is like a sickle
• Generally done under
local anesthesia on
OPD basis
Advantages of Rhomboid Flap

• Easily done under local anesthesia as an

outpatient
• Provides good color and texture match
• Although random pattern, it is generally very
robust because of adequate base to length ratio
• Easy to learn and teach
BCC with Radiation Necrosis
Exposed bone
Rhomboid Flap
(Limberg)
Neglected BCC for 1 year
Rhomboid excision planned
Excision & Reconstruction
under LA

Post Excisional Defect

Limberg Flap
Local recurrence in
breast cancer scar
94 Y F
BCC under
Pinna
Excision under LA
First post op day – extensive ecchymosis
2 weeks later
Intradermal Nevus on Face – 6 months post op
Use of Limberg Flap for Pilonidal Sinus Excision
 Summary

 Expertise in different methods of reconstruction

like local and distant flaps is essential for all
surgeons dealing with cancer & trauma in 3rd
World countries like ours
 Limberg (or Rhomboid Flap) is very reliable for
application in small defects
 Can be done under local anesthesia as day
case
 It is easily taught and learnt in the setting of a
 Cheema’s Aphorism

∞
Your ability to to your ability to
resect cancer is reconstruct