# Rapidly Growing and Aggressive Squamous Cell Carcinoma of the Forearm: A Report of Successful Treatment With Mohs Surgery and Complex Reconstruction With Rhombic Triple Z-Plasty

## TL;DR

A patient with aggressive skin cancer on the forearm was successfully treated with Mohs surgery and a complex reconstructive technique involving a modified rhombic flap with Z-plasties.

## Contribution

A modified rhombic triple Z-plasty technique is introduced for reconstructing complex forearm defects after Mohs surgery.

## Key findings

- The modified rhombic flap with three Z-plasties provided complete wound coverage and preserved extensor function.
- Long-term follow-up showed no tumor recurrence and satisfactory cosmetic and functional outcomes.
- The technique is effective for complex radial-dorsal forearm defects following tumor excision.

## Abstract

Reconstruction of complex post-surgical wounds requires functional and aesthetic considerations. We present a case of a complex radial-dorsal forearm defect in a patient who underwent Mohs surgery for an aggressive and rapidly growing squamous cell carcinoma. Following complete tumor excision, we utilized a modified rhombic flap for complete wound coverage with long-term conservation of extensor function. The rhombic flap modification included three Z-plasties at the flap base to add rotational components to the flap transposition. Long-term follow-up showed acceptable cosmesis, preserved extensor tendon function, and no evidence of tumor recurrence.