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Subject: Rotation Flap
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Surgical tray instruments are listed in Appendix G. Consider adding skin hooks to gently handle the skin flaps. Have at least three fine (mosquito) hemostats to assist with hemostasis while developing large skin flaps.
Suggested suture removal times are listed in Appendix J, and a suggested anesthesia tray that can be used for this procedure is listed in Appendix F. All instruments can be ordered through local surgical supply houses.
Closure of skin defects that require minimum skin removal, or where skin may be under tension from a variety of directions.
This flap work best for partial-thickness defects of the face, neck, and back.
Areas with poor blood flow.
Wounds best closed by other methods.
Presence of cellulitis, bacteremia, or active infection.
Heavy smokers and insulin-dependent diabetics present an increased risk of complications.
PEARL: The flap can always be enlarged if sufficient motion is not possible.
PEARL: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
PEARL: Surgical defects are typically round. A larger round defect may be closed without the creation of a triangle defect by undermining the flap and cutting the point of the flap off in a curve to match the edge of the defect.
PEARL: The flap pedicle should be placed inferiorly so that gravity aids in lymphatic and venous drainage.
PEARL: A tacking suture (to be removed later) can be placed to assess flap motion and placement.
PEARL: If tension is present in the flap, consider placing buried sutures to reduce the tension.
PEARL: Little mechanical benefit is gained in increasing flap length beyond a 90-degree arc. Increased undermining and increased arc radius gives small benefits on closing tension.
PITFALL: The Burow triangle should not be taken into the pedicle of the flap itself because this diminishes the blood supply; rather, it should be moved away from the flap.
Pain, infection, and bleeding
Nonunion of skin edges
Tissue sloughing (usually due to excess tension or the blood supply being disrupted by undermining)
Sensory changes (often subside with time)
Flap necrosis and sloughing
Distortion of neighboring landmarks