Rotation Flap

This is a semicircular skin flap that is rotated into the defect on a pivot point. Again, the flap must be sufficiently broad, and a broad base is necessary if a backcut is needed to lengthen the flap (Fig. 3.20). If the rotation flap is too small (Fig. 3.21a), the residual defect can be covered by mobilizing the surrounding skin (Fig. 3.21b, c).

Rotation Flap

Fig. 3.19 Rotation flap a The mobilized flap is rotated into the defect (D) after the excision of a Burow's triangle (B). b Appearance after closure of the defects.

Fig. 3.19 Rotation flap a The mobilized flap is rotated into the defect (D) after the excision of a Burow's triangle (B). b Appearance after closure of the defects.

Burow Triangle

Fig. 3.20 Transfer of a too small rotation flap aided by a back cut (see Fig. 3.19). a The flap is lengthened by making a back cut. b The defect (D) is closed, and the secondary defect is mobilized in the area of the back cut.

c Closure of all defects.

Fig. 3.20 Transfer of a too small rotation flap aided by a back cut (see Fig. 3.19). a The flap is lengthened by making a back cut. b The defect (D) is closed, and the secondary defect is mobilized in the area of the back cut.

c Closure of all defects.

Rotation Flap

Fig. 3.21 Transfer of a too-small rotation flap aided by mobilizing the surrounding skin. a Flap b The flap is rotated, and the surrounding skin is mobilized to close the residual defect (D) and secondary defect (S). If necessary, a skin triangle is excised over the secondary defect (-). c Closure of all defects.

Rotation Flap

Fig. 3.21 Transfer of a too-small rotation flap aided by mobilizing the surrounding skin. a Flap b The flap is rotated, and the surrounding skin is mobilized to close the residual defect (D) and secondary defect (S). If necessary, a skin triangle is excised over the secondary defect (-). c Closure of all defects.

Bilobed Flap

Fig. 3.22 Bilobed flap (Esser 1918).

a The angle between the defect (D) and the first lobe L1 equals the angle between L1 and lobe L2. If the skin is mobile, lobe 1 is approximately two-thirds the size of the defect, and lobe 2 is approximately two-thirds the size of lobe 1.

b The flaps and surrounding skin are mobilized, and lobe L1 is swung into the defect. Lobe L2 is swung into the secondary defect S1.

c The surrounding skin is mobilized, and all secondary defects are closed.

d Appearance after closure of all defects.

Fig. 3.22 Bilobed flap (Esser 1918).

a The angle between the defect (D) and the first lobe L1 equals the angle between L1 and lobe L2. If the skin is mobile, lobe 1 is approximately two-thirds the size of the defect, and lobe 2 is approximately two-thirds the size of lobe 1.

b The flaps and surrounding skin are mobilized, and lobe L1 is swung into the defect. Lobe L2 is swung into the secondary defect S1.

c The surrounding skin is mobilized, and all secondary defects are closed.

d Appearance after closure of all defects.

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