How to Do a Refined Rotational Flap

Rotation flaps are a reliable reconstructive option for moderate to large cutaneous defects, particularly in areas of limited tissue laxity. However, flap planning can be challenging for trainees or surgeons who perform these reconstructions infrequently. We describe a simplified and reproducible modification of Ahuja's rotation flap technique, using triangulation of the defect and proportional geometric landmarks to guide flap design. Key principles include a broad-based flap, generous rotational arc, preservation of vascularity and intraoperative adjustment using a 'cut-as-you-go' approach according to tissue laxity. This technique provides a practical visual framework for safe and efficient rotation flap planning while maintaining the reconstructive advantages of local like-for-like tissue transfer.