Reconstruction of Scalp Defects with Rotational Flaps: Where Is the Limit?

Background/Objectives: Scalp defect reconstruction often poses a challenge due to the distinct anatomy and limited skin elasticity of the region. Rotational flaps, when properly planned, offer a superior and creative solution for effectively covering most scalp defects. The aim of this study is to present the indications, and versatile use of rotational flaps in scalp reconstructive surgery, guided by an algorithmic approach and exemplified by numerous clinical applications. Methods: An observational cohort study was conducted between 2019 and 2024. The study protocol adhered to the ethical guidelines of the Declaration of Helsinki, was approved by the local ethics committee, and followed the STROBE statement for cohort studies. Results: A total of 152 rotational flaps were performed in 138 patients to reconstruct scalp defects, mostly following skin cancer excision. The defect size ranged from 30 to 96 mm in largest diameter (mean diameter, 52.8 ± 8.8 mm). Postoperative complications occurred in 13 cases (9.4%), and 5 cases (3.6%) required further surgical treatment, due to wound healing problems and/or necrosis. Based on high VAS scores (9.4 + 0.3), the cosmetic outcomes were deemed satisfactory, with excellent color and texture matching. Conclusions: This study underscores the critical role of meticulous surgical planning and technique in achieving optimal outcomes in scalp reconstruction. By combining the principles of tissue biomechanics with the versatility of rotational flaps, surgeons can effectively address a wide range of defects, achieving both functional and esthetic excellence.