Abstract Listings 2025

Purpose

The medial canthal area can be challenging to reconstruct in both a functional and aesthetic manner. This is owing to its multi-contoured surface with variations in skin thickness, colour and texture, as well as overlapping aesthetic units. We describe the use of the rhomboid flap (RF) in reconstruction of periocular defects.

Methods

This is a retrospective study of 39 patients undergoing reconstruction in the periocular region following Mohs micrographic surgery, using a rhomboid flap, over a 5 year period from January 2015 to December 2019.

Results

34 defects were in the medial canthal region. 12 defects involved the eyelid margin. Of the reconstructive methods used 74% were by a rhomboid alone, 26% were a combination of rhomboid flaps with other techniques. 13 patients (33.33%) had early post-op complications. Of which 12 resolved completely or partially with simple massage and topical antibiotics, only 1 needed further intervention for medial canthal scarring causing ectropion.

Conclusion

This study shows that the RF is a versatile flap for periocular reconstruction, especially in the medial canthal area. It is suitable to be performed under local anaesthesia, can be combined with other reconstructive procedures, and has minimal complications with excellent cosmesis. The technical ease, aesthetic and functional outcome, short surgical time, matching skin texture and colour and tension-free closure are some of the reasons to justify the use of the rhomboid flaps as a first-line option for periocular reconstruction.

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