They are nearly always random flaps comprised of skin and subcutaneous tissue devoid of segmental vessels. They ultimately rely upon perforators that course superficially to supply the dermal and subdermal plexuses. Allowing a facial wound to granulate may work well in small concave areas, but large defects may take several weeks to heal, and the resultant scar, especially in convex areas, will be thin and atrophy in comparison to surrounding skin. Skin grafts are usually a suboptimal choice in facial reconstruction for many reasons including poor aesthetic results, donor site disfigurement, minimal protection of underlying structures, and significant wound contraction with healing.
Local flaps take advantage of the plentiful blood supply and mobility of face and neck skin.
These features permit aggressive use of random flaps when a more extensive or invasive reconstruction would be required in other areas of the body. Rotation flaps can be designed to place incisions in relaxed skin tension lines and take advantage of adjacent areas of skin laxity or redundancy. These versatile flaps can be applied to many areas of the face and neck. The first step in designing a rotation flap is to outline an isosceles triangle around the defect. As a rule, the two sides of the triangle, which are equal in length, are longer than the third side, or defect base.