title: Double Z-plasty to enhance rhombic flap mobility.
abstract: BACKGROUND
  Occasionally after a rhombic flap has been designed, cut, and undermined, it fails to transpose into the recipient wound as easily as had been anticipated. This problem may have occurred because of unexpected skin tension due to previous surgery near the operative site or improper orientation of the rhombic flap.
  
  
  OBJECTIVE
  The purpose of this work is to show how unexpected restriction in rhombic flap movement can be overcome by using a double Z-plasty to increase tissue length.
  
  
  METHODS
  A double Z-plasty was incorporated into the rhombic flap design in one patient. The biomechanics of the flap were analyzed, and the modified flap was used in three other patients.
  
  
  RESULTS
  The addition of a double Z-plasty increased the movement of the rhombic flap in a predictable fashion in four patients.
  
  
  CONCLUSIONS
  A double Z-plasty is useful to enhance rhombic flap mobility in certain uncommon situations.
authors.affiliation: Department of Dermatology, University of Southern California, Los Angeles.
authors.forename: S C
authors.initials: SC
authors.lastname: Johnson
authors.forename: R G
authors.initials: RG
authors.lastname: Bennett
mesh_terms: D001696:Biomechanical Phenomena; D002921:Cicatrix / Q000473:pathology; D062109:Dermatologic Surgical Procedures; D004548:Elasticity; D004954:Esthetics; D005145:Face / Q000601:surgery; D006801:Humans; D012867:Skin / Q000473:pathology; D013524:Surgical Flaps / Q000379:methods* / Q000473:pathology