eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Rotation Flaps

Author: Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College
Coauthor(s): Michael Fozo, MD, Staff Physician, Department of Otolaryngology, New York Eye and Ear Infirmary, New York Medical College
Contributor Information and Disclosures

Updated: Nov 5, 2008

Introduction

Rotation flaps are local flaps that use adjacent tissue rotated in an arc to close a defect. They are nearly always random flaps composed of skin and subcutaneous tissue devoid of segmental vessels. They ultimately rely on perforators that course superficially to supply the dermal and subdermal plexuses. The network of blood vessels in the dermal plexus seems to be dominant over the subdermal system; its integrity is vital to flap survival.

Indications

Options for repairing facial defects include healing by secondary intention, skin grafting, or tissue transfer, which can be local, regional, or free. Allowing a facial wound to granulate may work well in small concave areas, but large defects may take several weeks to heal, and the resultant scar, especially in convex areas, is thin and atrophied in comparison to surrounding skin.

Skin grafts are usually a suboptimal choice in facial reconstruction for many reasons, including poor aesthetic results, donor site disfigurement, minimal protection of underlying structures, and significant wound contraction with healing. Local flaps take advantage of the plentiful blood supply and mobility of face and neck skin. These features permit aggressive use of random flaps when a more extensive or invasive reconstruction would be required in other areas of the body. Rotation flaps can be designed to place incisions in relaxed skin tension lines and take advantage of adjacent areas of skin laxity or redundancy.

Relevant Anatomy

See Surgical Therapy.

Contraindications

Rotation flaps are most commonly used for partial-thickness defects of the midface area. They work well for small-to-midsize defects of the nose, eyelids, and canthal regions. They can also be used to reconstruct more extensive defects of the malar region. The curvilinear design integrates well into these regions; however, it does not lend itself well to the midforehead or glabellar regions. Transposition flaps with straight lines, which can be oriented parallel to skin creases, are more appropriate in these areas. Random flaps are likewise ill suited for reconstruction of more extensive defects, such as full-thickness nasal deformities. Axial or multiple flaps or composite grafts may be better suited for these situations.

Heavy smokers or patients with insulin-dependent diabetes mellitus present an increased risk of complications with any flap. If the defect is created after excision of a carcinoma, confirm that margins are free of disease before any local flap covers the area.

More on Rotation Flaps

Overview: Rotation Flaps
Treatment: Rotation Flaps
Follow-up: Rotation Flaps
Multimedia: Rotation Flaps
References
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References

  1. Larrabee WF Jr, Sutton D. The biomechanics of advancement and rotation flaps. Laryngoscope. May 1981;91(5):726-34. [Medline].

  2. Cook TA, Israel JM, Wang TD, et al. Cervical rotation flaps for midface resurfacing. Arch Otolaryngol Head Neck Surg. Jan 1991;117(1):77-82. [Medline].

  3. Rieger RA. A local flap for repair of the nasal tip. Plast Reconstr Surg. Aug 1967;40(2):147-9. [Medline].

  4. Staahl TE. Nasalis myocutaneous flap for nasal reconstruction. Arch Otolaryngol Head Neck Surg. Mar 1986;112(3):302-5. [Medline].

  5. Calhoun KH, Seikaly H, Quinn FB. Teaching paradigm for decision making in facial skin defect reconstructions. Arch Otolaryngol Head Neck Surg. Jan 1998;124(1):60-6. [Medline].

  6. Connor CD, Fosko SW. Anatomy and Physiology of Local Skin Flaps. Facial Plast Surg Clin North Am. 1996;4:447-454.

  7. Cronin TD. The V-Y rotational flap for nasal tip defects. Ann Plast Surg. Oct 1983;11(4):282-8. [Medline].

  8. Green RK, Angelats J. A full nasal skin rotation flap for closure of soft-tissue defects in the lower one-third of the nose. Plast Reconstr Surg. Jul 1996;98(1):163-6. [Medline].

  9. Katz AE, Grande DJ. Cheek-neck advancement-rotation flaps following Mohs excision of skin malignancies. J Dermatol Surg Oncol. Sep 1986;12(9):949-55. [Medline].

  10. Klingensmith MR, Millman B, Foster WP. Analysis of methods for nasal tip reconstruction. Head Neck. Jul-Aug 1994;16(4):347-57. [Medline].

  11. McGregor IA. Fundamental Techniques of Plastic Surgery and Their Surgical Applications. Churchill Livingstone; 1989:65-90.

  12. Millman B, Klingensmith M. The island rotation flap: a better alternative for nasal tip repair. Plast Reconstr Surg. Dec 1996;98(7):1293-7. [Medline].

  13. Myers B, Donovan W. The location of the blood supply in random flaps. Plast Reconstr Surg. Sep 1976;58(3):314-6. [Medline].

  14. Nishioka GJ, Larrabee WF, Murakami CS, et al. Suspended circummandibular wire fixation for mixed-dentition pediatric mandible fractures. Arch Otolaryngol Head Neck Surg. Jul 1997;123(7):753-8. [Medline].

  15. Patterson HC, Anonsen C, Weymuller EA, et al. The cheek-neck rotation flap for closure of temporozygomatic-cheek wounds. Arch Otolaryngol. Jun 1984;110(6):388-93. [Medline].

  16. Rigg BM. The dorsal nasal flap. Plast Reconstr Surg. Oct 1973;52(4):361-4. [Medline].

  17. Schrudde J, Beinhoff U. Reconstruction of the face by means of the angle-rotation flap. Aesthetic Plast Surg. 1987;11(1):15-22. [Medline].

  18. Spector JG. Surgical management of cutaneous carcinomas at the inner canthus. Laryngoscope. May 1985;95(5):601-7. [Medline].

  19. Steinkogler FJ. Reconstruction of the lower lid. Br J Ophthalmol. Jul 1984;68(7):507-10. [Medline].

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Further Reading

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Keywords

rotation flap, rotation flaps, local flaps, random flaps, sliding nasolabial flap, cervical-facial rotation flap, cheek-neck rotation flap, dorsal nasal flap, full nasal skin rotation flap, island rotation flap, rotational flaps, rotational flap

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Contributor Information and Disclosures

Author

Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College
Anthony P Sclafani, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons
Disclosure: Medicis None Speaking and teaching; Contura None Board membership; Contura Grant/research funds Independent contractor; Cascade Medical Grant/research funds Independent contractor; Cascade Medical None Board membership

Coauthor(s)

Michael Fozo, MD, Staff Physician, Department of Otolaryngology, New York Eye and Ear Infirmary, New York Medical College
Michael Fozo, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Medical Society of the State of New York, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Gregory Branham, MD, Vice-Chair, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine
Gregory Branham, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David W Stepnick, MD, Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center
David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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