Double Z-rhombic repair of both large and small defects of the upper extremity

The use of single local flaps in the upper extremity to repair excisional defects together with direct repair of the flap donor region is limited by the potential for tension and joint contracture in the flap donor region. The double Z-rhomboid technique is a useful alternative to minimize these problems. The lesion is excised as a rhombus, and the defect is repaired with two opposing equilateral 60° Z-plasties. The technique effects closure of the primary defect as well as of the two smaller donor defects. By borrowing half of the required skin from opposite sides of the defect, excessive tension is avoided in repairing donor regions, and the technique may be used more safely in closer proximity to mobile joints. The technique has been used successfully in a wide variety of defects 4 to 70 cm2 in size.