Rhomboid flap in facial reconstruction. New concept of tension lines.

The rhomboid flap has become a popular reconstructive alternative for facial defects in recent years. Since the original description by Limberg, several modifications of the flap have been described, the most important of which was by Dufourmental. In the literature and at many soft-tissue courses, it has been taught that after rotation the maximum tension of the rhomboid flap is at the corner of the rhomboid most distant from the transposed flap. The author shows that the maximum tension of the flap is at the closure of the donor area. This phenomenon is amply illustrated with clinical cases. The Dufourmental modification is more satisfactory than the classical rhomboid flap in most cases because there is less tension on the closure. An understanding of these concepts is essential to the successful use of this important flap in order to avoid distortion of vital facial landmarks. I report a series of 30 consecutive rhomboid flaps.