Limberg's Rhombic Flap: A Review of Embryological, Anatomical, and Clinical Considerations.

Nearly a century ago, a new surgical approach was introduced for reconstructing rhombus-shaped defects by designing a highly versatile, geometrical, transpositional local flap, combining rotation and lateral shift. Known as the Limberg flap, this unique design is also known as the rhombic flap or, less precisely, the rhomboid flap. The rhombic flap is a full-thickness flap with a random pattern of blood supply, relying on vascularization from the dermal-subdermal plexus. It offers minimal donor site morbidity, reliable neurovascular supply, and a favorable aesthetic outcome. Over time, rhombic flaps have been widely adopted for the closure of small to medium-sized defects resulting from various clinical conditions across different anatomical regions. Successful implementation of this technique requires, first and foremost, a solid understanding of the embryological and anatomical characteristics of the flap, followed by a detailed overview of the exact technique and its modifications, as well as a step-by-step analysis of each surgical stage. This review aims to present the anatomical principles underlying the rhombic flap, highlight key aspects of its surgical application, including design, technique, contraindications, and complications, and underscore its clinical significance in contemporary reconstructive surgery.