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

Chapter
Part of the Clinical Cases in Dermatology book series (CLIDADE)

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).

Keywords

Rotation flaps Scalp Skin cancer 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Cutting C. Critical closing and perfusion pressures in flap survival. Ann Plast Surg. 1982;9:524.CrossRefPubMedGoogle Scholar
  2. 2.
    Baker S. Local flaps in facial reconstruction. 2nd ed. St Louis: Mosby/Elsevier; 2007.Google Scholar
  3. 3.
    Papel I. Facial plastic and reconstructive surgery. 2nd ed. New York: Thieme Medical Publishers; 2002.Google Scholar
  4. 4.
    Patel KG, Sykes JM. Concepts in local flap design and classification. Oper Tech Otolaryngol. 2011;22:13–23.CrossRefGoogle Scholar
  5. 5.
    Larrabee WF, Sutton D. The biomechanics of advancement and rotation flaps. Laryngoscope. 1981;91(5):726–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Throckmorton GS, Williams FC, Potter JK, Finn R. The geometry of skin flap rotation. J Oral Maxillofac Surg. 2010;68:2545–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Buckingham ED, Quinn FB, Calhoun KH. Optimal design of O-to-Z flaps for closure of facial skin defects. Arch Facial Plast Surg. 2003;5(1):92–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Dingman RO, Argenta LC. The surgical repair of traumatic defects of the scalp. Clin Plast Surg. 1982;9:131–44.PubMedGoogle Scholar
  9. 9.
    Gillies H, Millard Jr DR. Rotation flaps. In: Gillies H, Millard Jr DR, editors. The principles and art of plastic surgery. Boston: Little/Brown; 1957. p. 114–32.Google Scholar
  10. 10.
    Cohen PR, Martinelli PT, Schulze KE, et al. The purse-string suture revisited: a useful technique for the closure of cutaneous surgical wounds. Int J Dermatol. 2007;46:341–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Lin H, Li W. Complete closure using a double purse-string closure for skin defects. Dermatol Surg. 2009;35:1406–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Cohen PR, Martinelli PT, Schulze KE, et al. The cuticular purse string suture: a modified purse string suture for the partial closure of round postoperative wounds. Int J Dermatol. 2007;46:746–53.CrossRefPubMedGoogle Scholar
  13. 13.
    Michaelidis IG, Stefanopoulos PK, Papadimitriou GA. The triple rotation scalp flap revisited: a case of reconstruction of cicatricial pressure alopecia. Int J Oral Maxillofac Surg. 2006;35(12):1153–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Skin Cancer, School of MedicineUniversity of QueenslandBrisbaneAustralia
  2. 2.Faculty of SurgeryUniversity of AucklandAucklandNew Zealand
  3. 3.Skin Surgery ClinicAucklandNew Zealand

Personalised recommendations