For giant scalp tumors, advancement and rotation flaps (often combined) are crucial local techniques to cover large defects after tumor removal, providing tissue with similar hair-bearing properties for good function and aesthetics, using vessels like the superficial temporal or occipital artery for blood supply, though large flaps might require secondary skin grafting.

How they work
Advancement Flaps: Slide adjacent scalp tissue directly into the defect, useful for large, broad areas, sometimes using tension-releasing triangles (Burow’s).
Rotation Flaps: Pivot a flap of scalp tissue around a pivot point (vascular pedicle) to cover defects, often used for moderate to large anterior or lateral defects.
Combined/Complex Flaps: For very large defects, multiple rotation/advancement flaps are used, which rotate opposing flaps in a circular pattern to close central defects and minimize distortion.
Key considerations for giant tumors
Vascular Supply: Flaps are based on scalp arteries (temporal, occipital) to ensure blood flow
Donor Site: If the defect can’t be fully closed, the remaining secondary defect is often skin-grafted, resulting in bald areas.
Outcomes: These techniques offer good cosmetic results with reasonable tension, reducing necrosis risk, and can be combined with tissue expansion for better coverage.
Example in practice
A giant basal cell carcinoma on the scalp in our patient has been successfully treated with a combined rotation-advancement flap, demonstrating its effectiveness for complex cases.