The O-to-Z Rotation Flap: A Workhorse for Reconstruction of Scalp Defects

The presentation discusses the O-to-Z rotation flap technique, which involves two rotation flaps positioned opposite each other, effectively covering scalp defects with great versatility and vascularity. The speaker prefers this method for central scalp defects, especially when traditional advancement flaps are inadequate due to the inelasticity of scalp skin. This technique is designed to elongate the flap from the defect at an angle instead of a tangent, thereby preventing the flap from falling short during rotation. Several considerations are emphasized, including flap design, length, curvature, and placement, alongside techniques to manage redundancy and ensure cosmetic outcomes. The presentation showcases multiple patient cases demonstrating the flap's effectiveness in restoring natural appearance and contour, often blending well with the hairline. Key design tips include avoiding tangent incisions, maintaining a quarter-circle arc for the flap, and hiding surgical scars in natural skin tension lines. The use of multiple rotation flaps is encouraged where larger defects exist, distributing the closure across smaller flaps. Cosmetically successful outcomes with the O-to-Z flap are achieved through careful planning and execution.