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- Presentation
Rotation Flaps: Design, Execution, and Clinical Applications in Dermatologic Surgery
Description
The talk explains rotation flaps in dermatologic surgery, defining them as local, usually random-pattern flaps that pivot adjacent tissue along an arc to close defects while redistributing tension. Compared with advancement flaps, rotation flaps move from a pivot point and recruit laxity from a wider area, which can improve coverage and preserve blood supply if designed well. The speaker emphasizes careful planning: these flaps work best for round, oval, or triangular defects, and the arc should generally be long—often three to four up to eight times the widest diameter of the defect—to reduce tension and distortion. The pivot point is classically at the base of the flap, and wide undermining, especially near the pivot, increases mobility; Burrows triangles or dog-ear management may be used to improve movement. Assessment should include cosmetic subunits, ability to hide curvilinear scars, tissue thickness, need for tacking sutures, and local vascularity. Practical tips include planning a longer arc than you expect to need, adjusting after anesthetizing and undermining, and maintaining enough flap thickness to preserve perfusion. Clinical examples highlight use on the upper lip, cheek, temple, lateral forehead, lower temple, and scalp, with variations such as double rotation flaps and O-to-S style designs. Overall, the main takeaways are to plan generously, undermine widely, protect blood supply, and use the flap’s curved lines to create a cosmetically favorable repair.
View moreConclusions
- Rotation flaps are useful for reconstructing appropriately shaped facial and scalp defects because they recruit adjacent tissue through a broad arc while redistributing tension.
- Successful rotation flap design depends on planning a sufficiently long arc and a nonconstricted pivot point so that distal perfusion is preserved and closure tension is minimized.
- Wide undermining and adequate flap thickness are essential to achieve mobility without compromising blood supply, especially in random-pattern flaps.
- The best cosmetic outcomes come from placing incisions along natural cosmetic subunit borders or existing skin lines so the scar is less noticeable.
- A practical workflow for rotation flaps is to assess the defect and tissue laxity, test mobility intraoperatively, and then execute the flap conservatively, lengthening only as needed.
- Burrow’s triangles and tacking sutures can be used selectively to remove standing cones, offload tension, and improve flap positioning.
- Rotation flaps are particularly well suited for the upper cutaneous lip, cheek, temple/lateral forehead, and scalp.
- With careful planning and technique, rotation flap scars often settle well over time and can become minimally visible after healing.
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