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Objective:To explore the clinical efficacy of double opposing rhomboid flap in repairing facial skin defects.Methods:From January 2020 to December 2020, 30 cases of facial skin lesions were removed in the Department of Plastic and Aesthetic Surgery, the Affiliated Hospital of Qingdao University, including 12 males and 18 females, aged 14-65 years, with an average age of 34.2 years. The diameter of the facial skin defect wound was 0.5-2.0 cm. The patients with facial skin defect were repaired with double opposing rhomboid flap. All patients were followed up for 3-12 months.Results:The incisions of 30 patients were healed in one stage, and double opposing rhomboid flaps survived. Following-up for 3 to 12 months showed that the operation area was flat, the incision scar was not obvious, the texture and color of the operation area and the surrounding skin matched well, the surrounding organs were not deformed, the lesions were not recurrent, and the cosmetic effect was satisfactory.Conclusions:The double opposing rhomboid flap is an effective method to repair quasi-circular facial skin defects, which is worthy of clinical application.
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Epidermoid cysts are common, subepidermal, keratin containing nodules, found anywhere on the body in 3rd and 4th decade of life. Surgical treatment is by complete excision with wall of cyst intact. Author presents a 40-year-old male with multiple sebaceous cysts in close proximity to one another on his left thigh. Individual cyst excision would have lead to a difficult primary closure, need for multiple incisions, with contracture and poor cosmesis due to the close proximity of the cysts. instead, the cysts were excised in mass and limberg flap was used for reconstruction and primary closure. Patient was followed up for 6 months. The objective of this study was to prove that limberg flap yields superior cosmesis and healing by primary intention in reconstruction after excision of multiple epidermoid cysts.
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Introduction: The present study was conducted to note the osteological evidence of a synovial joint between clavicle and first rib in Indians. Material and Methods: The present study was conducted on 310 pairs of adult clavicles and first ribs, out of which 210 pairs were males and 100 pairs were females obtained from the Anatomy department of Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak. The articular facets were studied and measured with the help of a sliding Vernier caliper (Micropole). Results: Among 210 pairs (420 no.) of male clavicles examined, 6 clavicles (2.86%) had a circumscribed smooth articular facet with well-defined margins. Out of these 6 clavicles, 3 (1.43%) were of right side and 3(1.43%) were of left side. A corresponding facet was present on the first ribs of the same skeletons. The facets were found to be present unilaterally and that too in males only. The measurements of the articular facets on the rhomboid area of the clavicles and ribs were-the average length, width and elevation was 7mm, 5.4mm and 2.2mm respectively. Conclusion: These articular facets on the rhomboid area of clavicles and first ribs are osteological evidence of a synovial articulation between clavicle and first rib.
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Introduction: The present study was conducted to note the osteological evidence of a synovial joint between clavicle and first rib in Indians. Material and Methods: The present study was conducted on 310 pairs of adult clavicles and first ribs, out of which 210 pairs were males and 100 pairs were females obtained from the Anatomy department of Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak. The articular facets were studied and measured with the help of a sliding Vernier caliper (Micropole). Results: Among 210 pairs (420 no.) of male clavicles examined, 6 clavicles (2.86%) had a circumscribed smooth articular facet with well-defined margins. Out of these 6 clavicles, 3 (1.43%) were of right side and 3(1.43%) were of left side. A corresponding facet was present on the first ribs of the same skeletons. The facets were found to be present unilaterally and that too in males only. The measurements of the articular facets on the rhomboid area of the clavicles and ribs were-the average length, width and elevation was 7mm, 5.4mm and 2.2mm respectively. Conclusion: These articular facets on the rhomboid area of clavicles and first ribs are osteological evidence of a synovial articulation between clavicle and first rib.
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Objective: To explore the effectiveness of modified rhomboid flap for repairing facial skin and soft tissue defect. Methods: Between January 2016 and May 2018, 23 patients with facial skin and soft defect were repaired by the modified rhomboid flap. There were 10 males and 13 females with the median age of 27 years (range, 11-72 years). The primary tumor included pigmented nevus in 18 cases, basal cell carcinoma in 4 cases, and squamous cell carcinoma in 1 case. The defect location was nose in 8 cases, cheek in 4 cases, malar in 6 cases, forehead in 2 cases, and upper lip in 3 cases. The defect ranged from 0.8 cm×0.8 cm to 3.9 cm×3.9 cm. According to the location and size of facial tumors, the resection area of square lesions was designed. According to the mobility of surrounding tissues and the direction of dermatoglyphic lines, the rhomboid flaps with an angle of 45-60° was designed to repair the defect by tension-free rotation. Results: All the flaps survived and the incision healed by first intension. All patients were followed up 3-15 months (mean, 7.3 months). During follow-up, no tumor reoccurred; the color and texture of the flaps were similar with surrounding tissue. There was no obvious scar hyperplasia, nor traction of adjacent normal tissues, and patients were satisfied with the appearance. Conclusion: The application of modified rhomboid flaps in repairing facial skin and soft tissue defects caused by resection of round facial tumor has the advantages of flexible design, simple manipulation, and less trauma.
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Sacrococcygeal pilonidal disease (SPD) is a chronic an uncommon entity with a variety of alternatives for treatment. One of those is the excision of the sinus tract followed by a reconstruction with the rhomboid flap described by Dufourmentel. The aim of this paper is to describe the main phases of the technique. A detailed explanation of the key steps for the implementation of Dufourmentel flap for the treatment of SPD is exposed. Excision of sacrococcygeal pilonidal sinus followed by Dufourmentel rhomboid flap is an alternative to consider in the treatment of pilonidal disease.
La enfermedad pilonidal sacrococcígea (EPS) es una entidad clínica crónica e infrecuente. Para su tratamiento se han descrito numerosas alternativas. Una de ellas es la exéresis de la zona afectada seguida de un cierre primario sin tensión, por medio de un colgajo romboidal descrito por Dufourmentel. El objetivo de este artículo es describir las fases más relevantes de la técnica. Se realiza una detallada explicación de los pasos clave para ejecutar la exéresis romboidal de la zona afectada, con la ulterior rotación de un colgajo de Dufourmentel para el tratamiento de la EPS. La exéresis romboidal de EPS seguida de la rotación de un colgajo de Dufourmentel constituye una alternativa a considerar en el tratamiento de la EPS.
Subject(s)
Humans , Pilonidal Sinus/surgery , Surgical Flaps , Pilonidal Sinus/pathology , Sacrococcygeal Region/surgeryABSTRACT
ABSTRACT: Surgical excision of neoplasms usually requires a large incision with safety margin, resulting in large cutaneous defects. Skin flaps permit closure of extensive cutaneous defects that would not be closed directly. The rhomboid cutaneous flap can be used in places of the body where a rhomboid defect with internal angles of 60 and 120 degrees can be made. The aim of this paper is to report the her use for reconstruction of the defect created after resection of a tumor on dogs' face . Total removal of the tumor and a safety margin was performed, and then the surgical defect was reconstructed with a rhomboid cutaneous flap. The final result was satisfactory, with an esthetically and functional acceptable scar, a without deformities to the oral commissure or eye. The cutaneous flap was considered a viable alternative for reconstruction of large surgical defects, of relatively simple execution and good functional and cosmetic results.
RESUMO: Remoção cirúrgica de neoplasias geralmente exige uma excisão ampla com margem de segurança, o que resulta em grandes defeitos cutâneos. Retalhos cutâneos propiciam a possibilidade de fechar defeitos de pele extensos que não seriam fechados por sutura direta. O retalho cutâneo romboide pode ser usado em locais do corpo onde seja possível a criação de defeito romboide com ângulos internos de 60 e 120 graus. Neste trabalho, relata-se a utilização do referido retalho cutâneo para reconstrução de um defeito cirúrgico gerado após ressecção de tumor em face de cão. Foi realizada a excisão total do tumor com margem de segurança, seguida pela reconstrução do defeito resultante com retalho cutâneo romboide. O resultado final obtido foi satisfatório, com formação de uma cicatriz esteticamente aceitável e funcional, sem deformidades da comissura labial ou do olho. O retalho mostrou-se como uma alternativa viável para reconstrução de grandes defeitos cirúrgicos, de simples execução e com bons resultados funcionais e cosméticos.
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We report a pair of atypical rhomboideus muscles which originated higher than normal observed in a 49-year-old Korean male. Rhomboid muscles were not paralleogram shape but trapezoid with rhomboideus tertius attached inferior to the rhomboideus major muscles. Rhomboideus minor originated as tendon from the ligamentum nuchae of fourth and sixth cervical vertebrae level. The upper end of the origin of the rhomboideus major was the ligamentum nuchae between fifth and sixth cervical vertebrae level on the left side and the ligamentum nuchae at the sixth cervical vertebra level on the right side. The lower end of the origin of the rhomboideus major was the spinous process of the fourth thoracic vertebra on the left side and the spinous process of the second thoracic vertebra on the right side. The upper end of the origin of the rhomboideus tertius were the same as the lower end of the rhomboideus major and the lower end of the origin of the rhomboideus tertius were the spinous process of the fifth thoracic vertebrae on both sides. Whole rhomboideus muscle spanned over nine vertebrae. We compared these rhomboidei with previously reported variations and discussed its embryological and clinical significance.
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Female , Humans , Male , Middle Aged , Cervical Vertebrae , Muscles , Spine , Tendons , Thoracic VertebraeABSTRACT
A novel recombinant Bacille Calmette-Guerin (rBCG) vaccine co-expressed Eimeria tenella rhomboid and cytokine chicken IL-2 (chIL-2) was constructed, and its efficacy against E. tenella challenge was observed. The rhomboid gene of E. tenella and chIL-2 gene were subcloned into integrative expression vector pMV361, producing vaccines rBCG pMV361-rho and pMV361-rho-IL2. Animal experiment via intranasal and subcutaneous route in chickens was carried out to evaluate the immune efficacy of the vaccines. The results indicated that these rBCG vaccines could obviously alleviate cacal lesions and oocyst output. Intranasal immunization with pMV361-rho and pMV361-rho-IL2 elicited better protective immunity against E. tenella than subcutaneous immunization. Splenocytes from chickens immunized with either rBCG pMV361-rho and pMV361-rho-IL2 had increased CD4+ and CD8+ cell production. Our data indicate recombinant BCG is able to impart partial protection against E. tenella challenge and co-expression of cytokine with antigen was an effective strategy to improve vaccine immunity.
Subject(s)
Animals , Adjuvants, Immunologic/genetics , Administration, Intranasal , Antigens, Protozoan/genetics , BCG Vaccine/administration & dosage , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Chickens , Coccidiosis/prevention & control , Disease Models, Animal , Drug Carriers/administration & dosage , Eimeria tenella/genetics , Genetic Vectors , Injections, Subcutaneous , Interleukin-2/genetics , Protozoan Vaccines/administration & dosage , Spleen/immunology , Vaccines, Synthetic/administration & dosageABSTRACT
BACKGROUND: Triple advancement flap has been recently introduced to close the skin defect after Mohs microscopic surgery. OBJECTIVE: The aim of this study is to evaluate the clinical advantage of the modified triple advancement flap compared with rhomboid excision and closure. METHODS: The modified triple advancement flap was performed on nine patients with skin cancer. We observed the clinical course after surgery and compared the scar length and the amount of removed normal skin in triple advancement flap with those in rhomboid excision and primary closure, by using an image-analyzing program. RESULTS: The overall cosmetic and functional result was good. Partial flap necrosis was detected in one of nine patients, and hypertrophic scar developed in one of nine patients. The average scar length from the modified triple advancement flap was 102.1 mm, whereas it was 95.0 and 111.0 mm in 1:3 and 1:3.5 rhomboid excision with closure. The amount of removed skin was 716.3 mm2 in modified triple advancement flap, whereas it was 794.0 mm2 (1:3) and 1116.9 mm2 (1:3.5) in rhomboid excision with closure. CONCLUSION: The triple advancement flap might be used to close a defect in the area of trifurcation or bifurcation of skin tension lines, to spare the normal surrounding tissue as much as possible.
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Humans , Cicatrix , Cicatrix, Hypertrophic , Necrosis , Skin Neoplasms , SkinABSTRACT
OBJECTIVE: To investigate an appropriate depth of needle insertion during trigger point injection into the rhomboid major muscle. METHODS: Sixty-two patients who visited our department with shoulder or upper back pain participated in this study. The distance between the skin and the rhomboid major muscle (SM) and the distance between the skin and rib (SB) were measured using ultrasonography. The subjects were divided into 3 groups according to BMI: BMI less than 23 kg/m2 (underweight or normal group); 23 kg/m2 or more to less than 25 kg/m2 (overweight group); and 25 kg/m2 or more (obese group). The mean+/-standard deviation (SD) of SM and SB of each group were calculated. A range between mean+1 SD of SM and the mean-1 SD of SB was defined as a safe margin. RESULTS: The underweight or normal group's SM, SB, and the safe margin were 1.2+/-0.2, 2.1+/-0.4, and 1.4 to 1.7 cm, respectively. The overweight group's SM and SB were 1.4+/-0.2 and 2.4+/-0.9 cm, respectively. The safe margin could not be calculated for this group. The obese group's SM, SB, and the safe margin were 1.8+/-0.3, 2.7+/-0.5, and 2.1 to 2.2 cm, respectively. CONCLUSION: This study will help us to set the standard depth of safe needle insertion into the rhomboid major muscle in an effective manner without causing any complications.
Subject(s)
Humans , Back Pain , Muscles , Needles , Overweight , Pneumothorax , Ribs , Shoulder , Skin , Superficial Back Muscles , Thinness , Trigger Points , UltrasonographyABSTRACT
La glositis romboidal media (GRM) es una alteración benigna, poco frecuente, que afecta ligeramente más a los varones. Suele localizarse en la línea media del dorso de la lengua por delante de la V lingual, en forma de área rojiza, romboidal, de superficie plana, como una mácula o a veces exofítica, mamelonada, que puede sobresalir de 2 a 5 mm y en la que no se observan papilas filiformes. Se presenta el caso clínico de un varón de 50 años de edad que consulta por presentar una lesión en dorso de lengua, situada en la línea media.
Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual V, appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by2- 5 mm. This paper reports a case of rhomboid glossitis in a 50-year-old man who consulted for a lesion on the dorsum of the tongue, in a medial location.
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Humans , Male , Middle Aged , Glossitis/diagnosis , Glossitis/therapy , Diagnosis, Differential , Glossitis/etiology , Glossitis/pathologyABSTRACT
Objective To explore a new methodology with bilateral rhomboid dermal flaps for surgical treatment of inverted nipple. Methods 36 cases with 64 inverted nipples were involved in this study. Among these cases, 8 of them were evaluated as mild degree, while 19 moderate and 9 severe. In this procedure, the bilateral rhomboid incisions were designed. The rhomboid skin was deepithelialized and two dermal flaps were created. Then these two dermal flaps were filled crosswise through the tunnel beneath the nipple and fixed as supporting. After the operation, the continuous traction of the nipple lasted for one week, and sutured out 10 days later. Results None of these 36 cases appeared nipple blood circulation disorder after operation. Postoperative follow-up for 6 months-3 years showed that the appearance of the nipple was satisfactory. There were no recurrence and sensory disturbance. Conclusions The method introduced in this study is simple, the appearance of nipple is natural and no complication has been found. The incision is larvaceous while the scar is invisible. Meanwhile this method is also benefit for reserving the function of breast-feeding. It is proved to be an ideal method for correcting the inverted nipple.
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Subject(s)
Basophils , Carcinoma , Eosinophils , Hair Follicle , Head , Neck , Pilomatrixoma , Upper ExtremityABSTRACT
PURPOSE: Cryptotia is a congenital deformity in which the upper third of the auricle is buried under the temporal skin. It is rare in Caucasians, yet it is more common in Asians. Although a variety of methods to treat cryptotia have been introduced, there is still no acceptable single procedure that can successfully manage this deformity in its entity. We present a triangular V-Y advancement flap and rhomboid flap for correcting cryptotia that can overcome the diverse shortcomings of the conventional methods. METHODS: This operative method was used to correct 18 auricles in patients ranging in age from 4 to 33 years. A triangular flap was prepared over the auricle by making a skin incision according to Ohmori's method. Then a rhomboid flap with a side length of about 8 to 10 mm that sets the lower portion as a pedicle in the anterior region was prepared to supplement the contracted portion of the helix. The cartilage deformity was corrected by the banner flap or the radiating cartilage incisions with cartilage graft or high density polyethylene graft. RESULTS: We have treated 16 patients with severe cryptotia using this method and have obtained good aesthetic results. All cases showed widened scaphoid fossa and smooth triangular fossa of antihelix. There were no major postoperative complications, such as necrosis or infection of the flaps. CONCLUSION: Correction of cryptotia using the triangular V-Y advancement flap and rhomboid flap is useful a method for certain conditions, when a severe contraction of the helix is present.
Subject(s)
Humans , Asian People , Cartilage , Congenital Abnormalities , Contracts , Necrosis , Polyethylene , Postoperative Complications , Skin , TransplantsABSTRACT
The aim of this study was to pattern macroscopically, by use of computational tools, the number and distributionof the medullary striae (MS) of fourth ventricle. After removing 71 fresh human brain stems, each respectiverhomboid fossa was photographed. The MS were carefully identified to be shaped and fulfilled by means ofa digital pen, using the Adobe Photoshop CS3® program. For absolute and relative analyses of number anddistribution, it was considered the maximum and minimum numbers of striae; striae that reached the ipsilaterallateral recess; presence of horizontal or oblique striae, with or without parallelism; and striae located at pontineor bulbar part of the rhomboid fossa. At least two MS per side were macroscopically detectable in 90.6% ofcases; they were bilaterally absent in 5.3% of pieces; and at least one medullary stria was present in both sidesof the rhomboid fossa in 92% of cases. As on the right side (36% of cases) as on the left (26.6%), two MS werefrequently more present. In 60% of cases, striae reached ipsilateral lateral recess on the left, and in 40% of caseson the right. It was detected horizontal, (non-parallel) oblique and parallel striae in 50.7, 86.7 and 26.7%of cases, respectively. Medial medullary striae were observed in the bulbar part of rhomboid fossa in 80% ofpieces, and in 36% of cases in the pontine part. The MS of fourth ventricle show high morphological variabilitydegree in relation to number and distribution.
Subject(s)
Humans , Bone Marrow , Fourth Ventricle , Midline Thalamic Nuclei/anatomy & histology , Fourth Ventricle/anatomy & histology , Cerebrum , Computing Methodologies , Dissection , Fourth Ventricle/physiopathologyABSTRACT
Objective To explore the use of rhomboid skin flap in expanded skin flap transfer. Methods A rhomboid skin flap was designed if the top soft part could not be fully utilized after expanded in a rotation skin flap. The flap pedicels were designed near the incision side. It should be ensured that ra-tio of the length to the width of the composite flap, which was composed of the rhomboid skin flap and the rotation skin flap, was 2.5∶1.0. Results Among these 11 patients with re-designed rhomboid skin flaps in the rotation skin flaps, the ratio of the length to the width reached to 3∶1 in some cases, but 2. 5∶1.0 in most cases. All the skin flaps survived, except one patient with disturbance of blood circulation in a small area and one with mild congestion. Conclusion The expanded soft tissue can be fully and rationally utilized to repair the skin defect in this design. Attention should be paid to the ratio of the length to the width of the composited flap, and it is better to select axial flap as the composite flap for safety. This method is safe, and worthy of recommendation.
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PURPOSE: Recurrence of a pilonidal sinus after surgery is well known. Many surgical techniques have been developed but there is no efficient method available. This study evaluated the results of a Modified Rhomboid excision and Limberg flap of a pilonidal sinus, and examined the value of this method. METHODS: Five patients, who had been treated with a modified rhomboid excision and Limberg flap procedure for recurrent pilonidal sinus, were evaluated. The patient's age, gender, duration of symptoms, length of hospital stay, complications, time required for the return to normal activity, and prior history of surgery were evaluated. RESULTS: The mean age of the 5 patients (4 males and 1 female) was 22.7 years, and all had a history of previous surgery. The mean duration of symptoms was 4.2 years. Only one patient developed seroma. The mean hospital stay was 7.2 days, and the mean time to normal activity was 14.4 days. There was no recurrence. CONCLUSION: Modified Rhomboid excision and Limberg flap procedure is the optimal method for treating recurrent pilonidal sinus with low complication and recurrence rates.