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BMJ Case Rep. 2019 Aug 13;12(8). pii: e229420. doi: 10.1136/bcr-2019-229420.

Application of the pinwheel flap for closure of a large defect of the scalp.

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Plastic Surgery, BodySculpture, Thessaloniki, Greece.
General Surgery, East Kent Hospitals University NHS Foundation Trust, Ashford, UK.
Hepato-Pancreato-Biliary (HPB) Unit, Manchester Royal Infirmary, Manchester, UK.


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.


dermatology; skin


Conflict of interest statement

Competing interests: None declared.

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