Background: Rotation flaps are arcuate repairs that redistribute tension vectors and recruit adjacent and/or distant tissue laxity. Rotation allows for the closure of wounds that cannot be repaired along a single tension vector. A rich and evolving literature details the evolution of rotation as an elegant method of repair for surgical wounds.
Objective: The goal of this article is to understand the basic principles and proper execution of tissue rotation for the repair of facial operative wounds, with special attention given to the concept of pivotal restraint and with a step-by-step regional approach.
Methods and materials: A review of the literature of dermatologic surgery, plastic surgery, and otolaryngology leads to a detailed understanding of rotation flap design and execution.
Results: Proper rotation flap design allows for the closure of large and complex wounds that will not close along one motion while minimizing tension vectors that affect adjacent free margins.
Conclusions: The concept and execution of rotation are integral to the practice of dermatologic surgery. Proper design and undermining are essential to create an adequately sized flap and to free pivotal restraint to facilitate wound closure. In many cases, the arc of a rotation flap may be hidden within a natural cosmetic boundary, allowing for an elegant and minimally visible reconstruction.