Case Competition 2023 Case 7 Reconstruction with double rotation flap on scalp
Authors: Faisal Ghairat (MD) and Magnus Balslev Avnstorp (MD), Roskilde, SUH, Denmark
A 88-years old male was admitted for excision and reconstrution of a squamous carcinoma on the scalp.
History: Primary curretage treatment of lesions on the scalp by dermatologist. Histology with suspicion of PCC. Admitted to department of Plastic and Reconstructive surgery due to further developement of the wound on the scalp. Size 3 x 4 cm, with ulceration, erosion, bleeding and itching.
Surgery: Tumor excised in 1 cm margin to the periosteum, resulting in a large defect of 4,5x6cm.
As the periost was widely exposed we decided to perform af double rotation flap indstead of a skin graft.
The double rotation flap was chosen due to the location on the vertex cranii, where tissue could be recruited from both side og the defect.
Before and after
Pre-Operative Considerations
Transplantation of the skin in this old man with dementia. There is a risk that he removes the transplantation due to itching. So we decided to perform a double rotation flap. We started with a simple rotation flap but it was not possible to close the defedt due to the large size.
Therefore we performed a doubble rotation flap.
Step 1: Excision of the tumor
1 cm margin all around according to the national rules. You can see a big open defect, 5 x 6 cm.
Step 2: We decided to try simple rotation flap
Not possible because of the big defect
Step 3: Opening up the scalp skin
Due to the big defect we decided double rotation flap.
Step 4: Double rotation flap
Peroperative final result.
Step 5: Follow-up at 10 days
The result was succesfull at follow-up on 10th day.
Post-Operative Plan
Mobilization: Must keep the head elevated and avoid very hot drinks and food for the first 1-2 days. Soft diet (cold or middle temperature). Calm regimen until suture removal, must especially avoid hard physical activity incl. sports and cleaning Pain reliever: Tabl. panodil 1 g p.n. maximum 4 times a day. Suture removal: In the plastic surgery outpatient clinic 21 days postoperatively, staples must be removed. Outpatient check-up: in 1 week Antibiotics: flucloxacillin 1 g tablet x 4 times a day for a total of 7 days Histology answer: by letter or phone
