Scalp defect reconstruction with triple rotation flap: A case report

Abstract

Scalp surgeries are some of the surgeries frequently performed in dermatosurgery department. These surgical procedures may leave large defects, especially when performed for malignant condition in which wide margin has to be excised. Such large defects are difficult to close primarily when reconstruction with local flap is essential. Here we report a case of epithelioid angiosarcoma of the scalp in a 24-year-old man where excision and reconstruction were performed using triple rotation flap.

A simple modification in snail rotation flap used for scalp reconstruction

“…This study included seven patients,three females and four males with age ranging from 47-68 years with scalp defectsdue to different causes as shown in tables (1,2). Intraoperatively, approximation of flap and tissues was performed easily with flap stability, minimal tension, and less flap rotation.…”

“…Addition of a lateral arm to that circle with a width of nearly X cm at its widest part that extending to a point near to 270° is the modification in design, Fig. (1).…”

“…Scalp is unique and is different from other sites in the head and neck, it has the thickest skin in the human body and covers bone that protects the intracranial structures. [1] Topographically, scalp consists of two parts; a hair bearing zone represented by temporal, parietal and occipital and a non-hair frontal zone which contains occipito-frontalis muscle that is connected by the galea aponeurotica [2,3] Scalp defects are mainly due to trauma, tumor resection surgery, radiotherapy induced necrosis, burns and infections. [4] Due to the special nature of scalp tissue being inelastic, convex in shape, moreover, the paucity of the adjacent tissues and high adherence of its layers (three layers out of its five layers behave as one unit gliding over the pericranium of the skull), all these factors render reconstruction of scalp defects a challenging task.…”

“…[4] Due to the special nature of scalp tissue being inelastic, convex in shape, moreover, the paucity of the adjacent tissues and high adherence of its layers (three layers out of its five layers behave as one unit gliding over the pericranium of the skull), all these factors render reconstruction of scalp defects a challenging task. [5] Tissues adjacent to scalp defect are important in selection of the suitable reconstructive technique regarding tissue pliability, bone involvement and adherence to surrounding tissue due to burn or scar [2] Many techniques have been used in scalp reconstruction starting from a simple approximation of the two edges of the scalp lesion, rotation flaps with their techniques as triple rotation [1] , doubleopposing rotation [6] pinwheel flaps [7] up to utilization of regional flaps and tissue expanders. [8] Optimum scalp reconstruction is achieved via preservation of acceptable cosmetics and tension-free closure that provides a durable coverage especially in cases of exposure of calvarium or skull implants.…”

Successful basal cell carcinoma defect reconstruction using combination of rotation and advancement flap: Two case reports

“…Rotation flap is an alternative for moderate-sized defects of the lateral forehead regions since they have a wide base and thus an excellent blood supply. 9 However, they require relatively extensive cutting beyond the defect to develop the flap, thus increasing the risk of nerve damage and bleeding. Combination of both flaps proved to be successful in accomplishing the necessary coverage without excessive tension and resultant distortion.…”