Design
Authors: Christian Kaare Paaskesen, MD, Liv Schöllhammer, MD, Frederik Gulmark Hansen, med.stud. and Magnus Balslev Avnstorp, MD
Introduction
The rotation flap is named after its semicircular shape and curvilinear movement. It is designed immediately adjacent to the primary defect and is optimally used to cover triangular defects. When covering circular defects, a standing tissue cone or Burow triangle can be excised adjacent to the wound to create a triangulated defect, which is more suitable for closure.
Schematic design of a rotation flap
The dimensions of the potential defect determine the proportions of the preoperative drawing. When designing a rotation flap in a clinical setting, it is helpful to understand the ideal theoretical dimensions, as they provide a useful starting point for modifications. The secondary defect, which occurs along the incision line, requires the flap to be both rotated and advanced or stretched for optimal closure. Wide undermining of the flap and peripheral tissue is essential to improve tissue mobility.
Inequalities in incision line length can be addressed by draping and redistributing excess skin or by excising a Burow triangle. Additionally, a back cut or a Z-plasty at the end of the incision line can further facilitate rotation. As previously discussed, the size of the flap needed to cover a defect is always influenced by the quality and biomechanical properties of the skin.
Flap combined with a Z-plasty:
Figure 1 | Rotation flap combined with a potential Z-plasty.
The purple transparent area indicates the zone of potential excision, while the dotted lines represent the planned incision lines. The dimensions of the potential defect determine the proportions of the preoperative drawing.
The melanoma has been excised, and the flap is rotated into the defect. When combined with a Z-plasty to enhance rotation, the Z-plasty flaps are repositioned accordingly. Additionally, the flap can be undermined in the subcutaneous layer to further improve mobility and facilitate closure.
The flap is now closed.
Flap combined with a Burow triangle:
The purple transparent area indicates the zone of potential excision, while the dotted lines represent the planned incision lines. The dimensions of the potential defect determine the proportions of the preoperative drawing.
The melanoma has been excised, and the flap is rotated into the defect. Combined with a Burow trianlge, to enhance rotation. Additionally, the flap can be undermined in the subcutaneous layer to further improve mobility and facilitate closure.
The flap is now closed.
Double Rotation Flap
Also known as: Ying-Yang Flap
A double rotation flap is considered when the adjacent skin lacks sufficient laxity for single-sided flap closure or when a large single-sided arc is aesthetically undesirable.
The purple transparent area indicates the zone of potential excision, while the dotted lines represent the planned incision lines. The dimensions of the potential defect determine the proportions of the preoperative drawing.
The melanoma has been excised, and the flap is rotated into the defect. Like the normal rotation flap, this can be combined with either a Burow trianlge or a Z-plasty, to enhance rotation. Additionally, the flap can be undermined in the subcutaneous layer to further improve mobility and facilitate closure.
The flap is now closed.
Acknowledgement
- Illustrations: Christian Kaare Paaskesen, MD.
