Third refinement in rhomboid release of contractures by adding four-flap z-plasties.

Rhomboid release has been utilized in the reconstruction of flexion contractures. In this study a new refinement of the rhomboid subcutaneous flap with a combination of adjacent four-flap Z-plasties on both sides is presented. Satisfying functional results were obtained, keeping the rhomboid flap and the structures on the rhomboid flap in their original position. The new design of the previous rhomboid release - the "rhomboid flap and adjacent four-flap Z-plasties" - makes it possible to preserve important anatomical landmarks, such as hairy skin in the axilla, the nipple/areola complex, and the pubic area in the contracture, and is considered a good method of releasing burn or congenital contractures.