Journal of Plastic, Breast & Reconstructive Surgery·Peer-reviewed, open-access surgical case reportsPeer-reviewed · Open access
Faisal Ghairat, Magnus Balslev Avnstorp. Case 7 (2023): Reconstruction with double rotation flap on scalp. Journal of Plastic, Breast & Reconstructive Surgery. 2023.
Open access. © 2023 The Author(s). Published by the Journal of Plastic, Breast & Reconstructive Surgery. Copyright to this case is shared between the author(s) and the journal; authors may reuse their own case for education, presentations and social media.
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Faisal Ghairat, Magnus Balslev Avnstorp
A 88-years old male was admitted for excision and reconstrution of a squamous carcinoma on the scalp.
BeforeAfterA 88-years old male was admitted for excision and reconstrution of a squamous carcinoma on the scalp.
History: Primary curretage treatment of lesions on the scalp by dermatologist. Histology with suspicion of PCC. Admitted to department of Plastic and Reconstructive surgery due to further developement of the wound on the scalp. Size 3 x 4 cm, with ulceration, erosion, bleeding and itching.
Surgery: Tumor excised in 1 cm margin to the periosteum, resulting in a large defect of 4,5x6cm.
As the periost was widely exposed we decided to perform af double rotation flap indstead of a skin graft.
The double rotation flap was chosen due to the location on the vertex cranii, where tissue could be recruited from both side og the defect.
Transplantation of the skin in this old man with dementia. There is a risk that he removes the transplantation due to itching. So we decided to perform a double rotation flap. We started with a simple rotation flap but it was not possible to close the defedt due to the large size.
Therefore we performed a doubble rotation flap.
1
1 cm margin all around according to the national rules. You can see a big open defect, 5 x 6 cm.
2
Not possible because of the big defect
3
Due to the big defect we decided double rotation flap.
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Peroperative final result.
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Mobilization: Must keep the head elevated and avoid very hot drinks and food for the first 1-2 days. Soft diet (cold or middle temperature). Calm regimen until suture removal, must especially avoid hard physical activity incl. sports and cleaning Pain reliever: Tabl. panodil 1 g p.n. maximum 4 times a day. Suture removal: In the plastic surgery outpatient clinic 21 days postoperatively, staples must be removed. Outpatient check-up: in 1 week Antibiotics: flucloxacillin 1 g tablet x 4 times a day for a total of 7 days Histology answer: by letter or phone
