Rhomboid flap reconstruction for a large thoracic lipoma: Challenges and outcomes within a maritime floating hospital setting

Objectives: To demonstrate the feasibility of performing local flap transposition for large soft-tissue defects in resource-limited maritime environments and to evaluate the clinical outcomes of a Limberg (Rhomboid) flap for reconstruction in high-tension anatomical areas.

Background: Lipomas are common benign mesenchymal tumors that are usually slow-growing and asymptomatic. However, lesions subjected to repeated friction or mechanical stress may present with bleeding and raise suspicion for vascular tumors or malignancy. In archipelagic regions such as Indonesia, geographical and economic barriers often limit access to specialized reconstructive care. Under these conditions, where advanced imaging is frequently unavailable, surgical decision-making relies largely on clinical assessment. The Rumah Sakit Kapal Ksatria Airlangga (RSKKA) functions as a floating hospital designed to provide surgical services to remote island populations.

Case Presentation: A 48-year-old woman from Sailus Island, South Sulawesi, presented with a 3-year history of a progressively enlarging posterior thoracic mass measuring 7.5 × 2.5 × 1.8 cm. Due to the high-tension location and anticipated defect size after excision, primary closure was considered inadequate. Wide excision followed by reconstruction with a Limberg (Rhomboid) flap was performed under portable shipboard lighting.

Results: Histopathological examination confirmed a 22 g lipoma. The flap achieved tension-free closure without complications. 

Conclusions: Rhomboid flap reconstruction can be safely performed in austere maritime environments, highlighting the role of floating hospitals in improving access to reconstructive surgical care for remote populations.