Quiz Cases PhD Publications Upload Case About Sign up Login
Case Competition Overview

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


Procedure and cases

Card image cap

Case 1

Left Cheek reconstruction with VY- and transposition flap

Card image cap

Case 2

Brystrekonstruktion med breast sharing-teknik

Card image cap

Case 3

Reconstruction of an extensive circumferential leg defect using a preconditioned bipedicular MS-2-TRAM Free Flap

Card image cap

Case 4

Extensive scalp reconstruction using a free myocutaneus lattisimus dorsi flap

Card image cap

Case 5

Giant Panniculectomy in schizophrenic patient

Card image cap

Case 6

Nasal reconstruction with bilateral nasolabial flaps

Card image cap

Case 8

Removal of an axillary lymphnode

Card image cap

Case 9

Malignant Phyllodes Tumor of the Breast

Card image cap

Case 10

1st dorsal intermetacarpal artery flap (Foucher flap)

Card image cap

Case 11

Paramedian forehead flap for nasal soft tissue reconstruction

Want to contribute?

Add your case now

Watch video