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Facial Flaps


Authors: Liv Schöllhammer, MD, Frederik Gulmark Hansen, med.stud. and Magnus Balslev Avnstorp, MD


Named after its semicircular shape and curvilinear movement and designed immediately adjacent to the primary defect

Optimally used to cover triangular defects. When covering a circular defect, a standing tissue cone or Burow triangle, can be harvested adjacent to the wound to create a triangulated defect

Schematic design of a rotation flap

The ideal design of a rotation flap is a perfect partial arch into a triangle with a width:height ration of 1:2. This ideal design rarely fits the clinical situation, hence in a clinical setting the rotation flap is almost always a modified version of the ideal schematic design. When designing a rotation flap in the clinical setting, it can be useful knowing the ideal theoretic dimensions.

Figure 1 | Standard principle of the rotation flap
Figure 2 | Modified rotation flap (Hatchet Flap)
  • The secondary defect occurs along the incision line. To cover it, the flap must not only be rotated but also advanced/stretched
  • Wide undermining of flap and peripheral tissue is important for better tissue movement
  • Inequality in length occurs along the incision line can be addressed by draping and thereby distributing the excess skin or by excising a Burow triangle
  • A back cut at the end of the insicion line can be made to further enable rotation

Flap Proportions

As discussed earlier the size of a flap needed to cover a defect is always dependent on the quality and biomechanical properties of the skin.

A general proportion guideline when designing rotation flaps in the face and neck area follows.

  • 4:1 ratio: The length of the incision (arc) should be four times the width of the primary defect.
  • 2:1 ratio: height-to-width configuration of the triangular primary defect
  • Finally the height of the triangular primary defect should be 0,5-1 times the radius of the curve of the semicircular flap.

Only a minimal benefit is gained when extending the arc of rotation flaps beyond 90 from the axis of the defect.

When working in tissue with little flexibility it can be necessary to widen length of the arc above a 4:1 ratio.

Double Rotation Flap

Also known as: Ying-Yang Flap

A double rotation flap can be considered in cases where the adjacent skin does not provide enough laxity for single-sided flap closure or when for aesthetic reasons a large single-sided arc is undesirable.

Figure 3 | Double Rotation flap


  • Illustrations: Christian Kaare Paaskesen, med.stud.


  • Starkman SJ, Williams CT, Sherris DA. Flap Basics I. Rotation and Transposition Flaps. Facial Plast Surg Clin N Am 25 (2017) 313–321
  • LoPiccolo MC, Rotation Flaps-Principles and Locations. Dermatol Surg 2015;41:S247–S254
  • Baker SR. Flap classification and design. In: Baker SR, editor. Local flaps in facial reconstruction. Philadelphia: Mosby Elsevier; Third edition, 2014. p. 71-107.
  • Baker SR. Rotation flaps. In: Baker SR, editor. Local flaps in facial reconstruction. Philadelphia: Mosby Elsevier; Third edition, 2014. p. 108-130.

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