Editing Skin flap techniques (section)

== Rotation flap ==

* Mark excision as a circle
* Convert circle to an isosceles triangle, with width being 3x the lesion diameter
* Mark pivot point at apex of triangle
* Mark circumference
* Diameter should be at least 4-5x the size of the defect
* Rotation flap on the scalp can be in any direction, but you can try to design it so the scar will be at right angles to the fall of the hair, where it will be less noticeable
* On the scalp, cut down through skin and galea to get into the loose areolar plane between galea and periosteum. Expect bleeding from around the galea and subcutaneous layer, which is difficult to control with cautery. Control the major bleeders, but otherwise just operate quickly and start suturing.
* Full 180 degrees of mobilisation is generally necessary before it starts to move
* First suture is between the leading edge and the far side of the defect. There shouldn't be much tension - if there is, make a back cut, but make it as small as possible.
* If can't close - 
** make a back cut - moves the functional pivot point closer to the lesion, and will reduce closing tension, at the cost of worse blood supply
** Undermine
** Double rotation flap