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
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
