Closure of complex vulvar defects using local rhomboid flaps.

Because primary closure under tension is frequently associated with wound breakdown and prolonged healing, we have used local rhomboid flaps as a technique for vulvar reconstruction when primary closure is not adequate. We evaluated the range of clinical applications, perioperative and long-term complication rates, length of hospital stay, and patient reaction to the rhomboid flap repair. Fifteen rhomboid flaps were constructed in 13 patients who underwent extensive vulvar resections between 1989-1994. Partial primary closure was combined with flap construction in 11 patients. Flap size ranged from 2.5 x 2.5 to 6 x 6 cm. Two women had minor wound separations. There were no other early or delayed vulvar complications. The six women with partners were able to resume sexual activity postoperatively. Rhomboid flaps provide excellent design flexibility for closure of large complex vulvar defects with minimal morbidity and acceptable cosmetic and functional results.