{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:17:07Z","timestamp":1792898227907,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,9]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>A 74-year-old man had a resultant large oval scalp defect of 12\u00d76 cm (72 cm<jats:sup>2<\/jats:sup>) 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\u2009cm). The incision was made through galea aponeurosis and subsequently undermined at least 3\u2009cm 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.<\/jats:p>","DOI":"10.1136\/bcr-2019-229420","type":"journal-article","created":{"date-parts":[[2019,8,14]],"date-time":"2019-08-14T07:17:00Z","timestamp":1565767020000},"page":"e229420","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Application of the pinwheel flap for closure of a large defect of the scalp"],"prefix":"10.1136","volume":"12","author":[{"given":"Ioannis","family":"Varnalidis","sequence":"first","affiliation":[{"name":"Plastic Surgery, BodySculpture, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7109-943X","authenticated-orcid":false,"given":"Angelos","family":"Mantelakis","sequence":"additional","affiliation":[{"name":"General Surgery, East Kent Hospitals University NHS Foundation Trust, Ashford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry Victor Michael","family":"Spiers","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary (HPB) Unit, Manchester Royal Infirmary, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athina N","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Plastic Surgery, BodySculpture, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,13]]},"reference":[{"key":"2025082709432074000_12.8.e229420.1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20487"},{"key":"2025082709432074000_12.8.e229420.2","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.6.1.54"},{"key":"2025082709432074000_12.8.e229420.3","first-page":"E666","article-title":"Local flap reconstruction of large scalp defects","volume":"13","author":"Garc\u00eda del Campo","year":"2008","journal-title":"Med Oral Patol Oral Cir Bucal"},{"key":"2025082709432074000_12.8.e229420.4","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/1477-7819-9-129","article-title":"Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection?","volume":"9","author":"Denewer","year":"2011","journal-title":"World J Surg Oncol"},{"key":"2025082709432074000_12.8.e229420.5","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4103\/JCAS.JCAS_138_16","article-title":"Reconstructions of small scalp defects with step flap","volume":"10","author":"Ebrahimi","year":"2017","journal-title":"J Cutan Aesthet Surg"},{"key":"2025082709432074000_12.8.e229420.6","doi-asserted-by":"crossref","first-page":"112","DOI":"10.7181\/acfs.2017.18.2.112","article-title":"Reconstruction of a complex scalp defect after the failure of free flaps: changing plans and strategy","volume":"18","author":"Kim","year":"2017","journal-title":"Arch Craniofac Surg"},{"key":"2025082709432074000_12.8.e229420.7","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000011114","article-title":"Pacman flap for oncologic reconstruction of soft-tissue defects after tumor resection: a retrospective case series","volume":"97","author":"Li","year":"2018","journal-title":"Medicine"},{"key":"2025082709432074000_12.8.e229420.8","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1097\/01.sap.0000123346.58418.e6","article-title":"Scalp reconstruction: a 15-year experience","volume":"52","author":"Newman","year":"2004","journal-title":"Ann Plast Surg"},{"key":"2025082709432074000_12.8.e229420.9","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.ijom.2006.05.005","article-title":"The triple rotation scalp flap revisited: a case of reconstruction of cicatricial pressure alopecia","volume":"35","author":"Michaelidis","year":"2006","journal-title":"Int J Oral Maxillofac Surg"},{"key":"2025082709432074000_12.8.e229420.10","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000076394.39302.9F"},{"key":"2025082709432074000_12.8.e229420.11","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4997\/jrcpe.2017.302","article-title":"Cutaneous melanoma: an updated SIGN Guideline","volume":"47","author":"Brown","year":"2017","journal-title":"J R Coll Physicians Edinb"},{"key":"2025082709432074000_12.8.e229420.12","unstructured":"National Institute for Health and Care Excellence. 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