PT  - JOURNAL ARTICLE
AU  - Ioannis Varnalidis
AU  - Angelos Mantelakis
AU  - Harry Victor Michael Spiers
AU  - Athina N Papadopoulou
TI  - Application of the pinwheel flap for closure of a large defect of the scalp
AID  - 10.1136/bcr-2019-229420
DP  - 2019 Aug 01
TA  - BMJ Case Reports
PG  - e229420
VI  - 12
IP  - 8
4099  - http://casereports.bmj.com/content/12/8/e229420.short
4100  - http://casereports.bmj.com/content/12/8/e229420.full
SO  - BMJ Case Reports2019 Aug 01; 12
AB  - A 74-year-old man had a resultant large oval scalp defect of 12×6 cm (72 cm2) following an excision of a stage IIIA melanoma. We decided to cover the defect with the pinwheel flap, with the aim to provide a good cosmetic result, preservation of hair follicles and minimal donor-site morbidity. This local flap has been traditionally used for much smaller defects. Four L-shaped flaps were designed at equal distances on the vertical and horizontal axes of the defect. The L-shaped flap had a length of 1.5 times the half diameter of the defect (4.5 cm). The incision was made through galea aponeurosis and subsequently undermined at least 3 cm to assist flap advancement. Z-plasties increased the rotation of the flap when it was required. This yielded an excellent reconstructive result at 1-year follow-up, demonstrating the usefulness of the pinwheel flap in large defects on the scalp region.