Background: Soft tissue reconstruction requires a thorough understanding of both anatomy and tissue movement. Flaps and grafts should be considered when simpler closure methods result in excessive tension or distortion of surrounding structures. Objective: We describe our experience with the birhombic transposition flap. Methods: The birhombic flap was used to repair 19 surgical defects after excision of skin cancer. Results: The average defect size was 3.0 x 2.4 cm with the 19 wounds located on the nose (6), forearm (5), hand (4), forehead/temple (3), and preauricular cheek (1). No cases of excessive tension, infection, or flap necrosis occurred. Conclusion: Conceptualization of a larger defect into multiple smaller defects may be useful to facilitate closure of each smaller defect in an easier fashion. Our series demonstrates the usefulness of this concept with the birhombic transposition flap repair.
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