Rotation Flaps of the Scalp: Study of the Design, Planning and Biomechanics of Single, Double and Triple Pedicle Flaps

Abstract

The scalp is a common site of skin cancer. Rotation flaps are considered workhorses when it comes to reconstructing scalp defects following skin cancer surgery or after surgery to correct alopecia. These are ‘random flaps’ i.e. depend on the vascular supply of the subdermal plexus and not based on a named skin perforator or specific cutaneous artery (the latter are termed ‘axial’ pattern flaps). The length of the random flap depends on the intravascular resistance of the supplying vessels and the perfusion pressure. When the perfusion pressure drops below a critical closing pressure of the arterioles in the subdermal plexus, nutritional blood flow ceases and flap ischemia occurs [1]. Another way to differentiate random flaps is to classify them based on it their movement is pivotal (rotating about a pivot as in rotation, rhomboid or bilobed flaps) or advancement flaps (wherein the skin is advanced forward with little sideways movement).