From the Guidelines
A rotational flap should be used when a wound or defect cannot be closed primarily due to tension or tissue loss, particularly in areas with limited tissue mobility, as seen in the management of stage IV pressure injuries, where a musculocutaneous rotational flap can be effective in reconstructing the wound 1. When considering the use of a rotational flap, it is essential to evaluate the size and shape of the defect, as well as the surrounding tissue's mobility and blood supply. Rotational flaps are ideal for circular or triangular defects on curved surfaces, such as the face, scalp, trunk, or extremities. The flap should be designed to maintain a broad base, preserving vascularity, and should be 2-4 times larger than the defect to minimize tension. Incisions should follow relaxed skin tension lines when possible, and the surgeon must ensure adequate blood supply to the flap, avoid excessive tension at closure, and consider the natural contours of the area to achieve optimal cosmetic results.
Some key considerations when using rotational flaps include:
- The type of defect being reconstructed, such as skin cancer excision, trauma, or pressure ulcers
- The location of the defect, with rotational flaps being particularly useful for areas with limited tissue mobility
- The size and shape of the defect, with larger defects requiring larger flaps to minimize tension
- The blood supply to the flap, with a broad base and adequate perfusion being essential for flap survival
- The natural contours of the area, with the flap being designed to match the surrounding tissue's color, texture, and thickness for optimal aesthetic outcomes.
In certain cases, such as anal carcinoma, the use of a rotational flap may be considered for perineal wound reconstruction, particularly when radiation therapy has been used, as it can help reduce perineal wound complications 1. Additionally, in the management of vascular graft infections, rotational flaps may be used to cover the wound and promote healing, particularly when combined with meticulous débridement and antimicrobial therapy 1.
The decision to use a rotational flap should be based on the individual patient's needs and the specific characteristics of the defect, with the goal of achieving optimal wound closure and minimizing morbidity and mortality.
From the Research
Indications for Rotational Flaps
- Rotational flaps are used to close wounds that cannot be repaired along a single tension vector 2
- They are ideal for recruiting adjacent tissue and redirecting vectors of tension to reconstruct wounds not amenable to primary closure 3
- Rotational flaps can be used to repair large and complex wounds, minimizing tension vectors that affect adjacent free margins 2
Specific Applications
- Rotational flaps are commonly used in facial reconstruction, particularly for defects resulting from Mohs surgery and other traumatic injuries 4
- They can be used to repair scalp defects, especially when the defect is large and primary closure is not possible 5
- Rotational flaps can also be used to close donor sites in the back, created by harvesting scapular and parascapular flaps 6
Key Principles
- Proper design and undermining are essential to create an adequately sized flap and to free pivotal restraint to facilitate wound closure 2
- The concept and execution of rotation are integral to the practice of dermatologic surgery, and mastering the technique of the rotation flap will allow a surgeon to repair a wide variety of cutaneous defects 3
- A well-planned and executed local flap, including rotational flaps, can lead to excellent cosmetic results with minimal distortion of the surrounding facial landmarks 4