Reconstruction of a High-Tension Post-Mohs Defect with Bilateral Rhombic Transposition Flaps and Double Z-Plasties: A Case Report

Abstract

Large defects on the upper back may be difficult to reconstruct effectively due to the highly tensile and inelastic qualities of local skin. Moreover, some patients tend to have kyphotic curvature of the spine, which can exacerbate the tensile forces on a primary closure. We present a post-Mohs surgical case of a mid-central back defect managed using bilateral rhomboid transposition flaps, each with double Z-plasties. This approach allowed for complete redirection of tension vectors and provided the necessary tissue laxity for optimal wound closure. The incorporation of Z-plasties facilitated skin lengthening during flap rotation, enhancing the overall reconstruction. Postoperatively, the patient achieved complete wound healing without complications. This technique demonstrates the positive effect of combination transposition flaps in addressing complex defects in areas with limited tissue availability.