Case Competition 2023 Case 7 Reconstruction with double rotation flap on scalp
Authors: Faisal Ghairat, Resident, Roskilde Hospital, Denmark
A 88 year old man admitted to our department through the dermatologist.
History: Curettage treatment of the scalp in 2022. Histology showed suspicion of PCC. Patient came to us in januar 2023 with the developement of the wound on the scalp. Size 3 x 4 cm, ulcerative, erosive, 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.
Before and after
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.
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