The rotating island pedicle flap: an aesthetic and functional improvement on the subcutaneous island pedicle flap.

Abstract

The subcutaneous island pedicle flap is a useful closure in many areas on the face, particularly the cheek and upper lip. One disadvantage can be that the advancing edge of the flap leaves a scar at right angles to the local lines of relaxed skin tension. Tension on free edges such as the lid can also be a problem, but may be mitigated by incorporating an element of rotation into the closure. A variation on the subcutaneous island pedicle flap is described to help avoid the problems of the subcutaneous island pedicle flap while retaining its strengths. Our experience with more than 120 rotating island pedicle flaps over 10 years is described to demonstrate the versatility of this subcutaneous island pedicle flap for facial and reconstructive surgery. The technique is described and seven representative cases are presented with photographs. The flap is simple to perform, has minimal complications, and has good cosmetic results. Temporary alteration of sensation in the flap skin is a possible complication and can be largely avoided with a bipedicled dissection technique. Our experience shows the rotating island pedicle flap to be versatile, reliable, and aesthetic island pedicle flap for skin cancer surgery both on and off the face and a practical modification of the subcutaneous island pedicle flap.