Chapter 7 - ROTATION FLAPS

Abstract

Rotation flaps are pivotal flaps with a curvilinear configuration. By necessity they must be designed immediately adjacent to the defect. Thus a border of the defect becomes the advancing border of the skin flap. Although useful in many clinical situations, the configuration of rotation flaps creates curved incisions that frequently do not lie completely in relaxed skin tension lines (RSTLs). There are several advantages of using rotation flaps. The flap has only two sides; as a result, the surgeon can sometimes position the arced incision in an aesthetic border. The flap is broad-based and therefore its vascularity tends to be reliable. There is great flexibility in design and positioning of the flap. As with all pivotal flaps, rotation flaps develop standing cutaneous deformities at the base of the flap that cannot be easily removed without compromising the vascularity of the flap. Rotation flaps are best suited for repair of defects that are triangular in shape. As a general rule, when designing rotation flaps on the face, the length of the flap should be four times the width of the base of the triangular shaped defect. Rotation flaps are the preferred method to repair most scalp defects with use of local tissue. Because of its spherical topography, the scalp accommodates curvilinear incisions well and flaps can be constructed sufficiently large without the need to regard RSTLs or aesthetic borders. Rotation flaps work extremely well in repair of large cheek defects greater than 3 to 4 cm in the lower preauricular area where recruitment of the upper posterior cervical skin is required for wound closure. The curvilinear incision is positioned juxtaposed to the earlobe and along the hairline of the postauricular scalp. Rotation flaps are useful for repair of small (less than 2 cm) skin defects of the lateral forehead and temple. Usually a single rotation flap is used, and whenever possible the arc of the flap is designed along the anterior hairline. In many circumstances, rotation flaps are an excellent choice for repairing cutaneous defects of the chin. Typically, two opposing flaps are designed, one on either side of the defect.