Application of a rhomboid flap for the coverage of defects after malignant breast tumor resection: A case report

Abstract

Abstract. Resection for locally advanced breast cancer (LABC) or malignant phyllodes tumors may cause a large skin defect with bone exposure. Although skin grafts are frequently used to cover such defects, they can result in poor cosmetic outcomes and graft acceptance is dependent upon the condition of the recipient site. To overcome the limitations of skin grafts, various flaps have been developed to cover such defects. The present study used a rhomboid flap for the coverage of skin defects after mastectomy and breast-conservative surgery (BCS). A total of 11 patients with malignant breast cancer underwent reconstructive surgery using the rhomboid flap between September 2011 and December 2013 (mastectomy, 9 patients; BCS, 2 patients). Skin resection size, axillary lymph node dissection, bone exposure, length of surgery, wound complications and whether preoperative/postoperative adjuvant therapy was received were analyzed. The maximum size of skin defect covered with the rhomboid flap in the present study was 20x20 cm. There were no major wound complications and all patients underwent postoperative adjuvant therapy on schedule. During BCS, a portion of the flap was used for augmentation of the breast, in addition to coverage of the skin defect, which resulted in good cosmetic outcomes. The rhomboid flap can be quickly and easily fashioned, and it does not require any special instruments.

Rhomboid Flap Reconstruction after Mastectomy for Locally Advanced Breast Cancer

“…As an alternative method to the skin graft and myocutaneous flaps, we described the usefulness of rhomboid flap (local, cutaneous flap) reconstruction for skin defects after malignant breast tumor resection in an earlier report 1 . The rhomboid flap reconstruction method has been frequently used since Limberg described it in 1946 19 , and some modified methods have been reported [20][21][22] .…”

“…Rhomboid flap reconstruction was performed according to the description in our earlier report 1 . The fundamental design of the rhomboid flap is shown in Figure 2.…”

“…Skin grafts and several types of myocutaneous flaps have reportedly been used for reconstruction in such cases, but in an earlier report, we presented the merits of local, cutaneous (rhomboid) flap reconstruction for large skin defects and the favorable outcomes with regard to postoperative complications and wound healing 1 . However, there are no comparative studies on mastectomy requiring local flap reconstruction and mastectomy alone in patients with LABC.…”