Rotation

Description

Rotation flaps are random-pattern sliding pivotal flaps with a curvilinear design. The flap sweeps into a triangular defect, pivoting at the base of the defect like the hand of a clock. The apex of the triangle is directed toward the base of the flap. After rotation of the skin into the defect, a dog-ear at the base of the flap may be created and can be excised with a Burow's triangle. The length of the curvilinear incision for the flap should be approximately four times the length of the defect (12) to minimize wound closure tension.

Indications

Rotation flaps are well-suited for closure of triangular-shaped defects with one side of the triangle representing the advancing edge of the flap. Extensive areas of the face including the cheek and neck are amenable to rotation flap closure (Fig 7). This is often the method of choice for closure of scalp defects; however, longer flaps are often required because the skin of the scalp is less distensible. More limited defects of the chin may also be closed using this flap. It may be difficult to camouflage a curvilinear incision in the forehead, so rotation flaps have a limited role in this area. The glabellar area is an exception and smaller tissue rotations are acceptable. Because of the large incision, rotation flaps have a very limited role in nasal reconstruction. The arc is 90 degrees and the diameter 3D, depending on the length of the curvilinear incision.

Advantages

The flap is very reliable with a broad base and a very low length-to-width ratio. The scars left after a rotation flap are of a simple curvilinear design and can often be hidden at aesthetic unit borders or directed with the RSTLs. There is virtually no limit to the size of a rotation flap: it can encompass the entire ipsilateral cheek to |

close large medial cheek-upper lip defects. ^

Disadvantages

The defect needs to conform to a triangle with its base along the incision for the flap. o

The incision is very lengthy; if it crosses an aesthetic unit border another local flap should be considered.

Figure 7 Cervicofacial rotation cheek flap cheek. An elliptical incision is made to follow the zygomatic arch and preauricular area (A) and widely undermined in the subcutaneous plane (B). The flap is advanced (by rotation, C) facilitated by a back cut near the earlobe. Final operative result shown in D.

Figure 7 Cervicofacial rotation cheek flap cheek. An elliptical incision is made to follow the zygomatic arch and preauricular area (A) and widely undermined in the subcutaneous plane (B). The flap is advanced (by rotation, C) facilitated by a back cut near the earlobe. Final operative result shown in D.

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