The entire length of the flap incision now can be closed with a nonabsorbable suture. The second delay is performed 1 week later under local anesthesia. A full thickness incision is made through the remaining galea bridge and then reapproximated. The result is termination of blood supply from the ipsilateral occipital artery, leaving the flap dependent upon the superficial temporal artery for circulation. The third stage, rotation of the flap, is performed 1 week after the second delay.
Rotation usually is performed under intravenous sedation.
To close the donor defect, the surrounding scalp is widely undermined, extending as far as the upper cervical skin. The donor defect now can be closed, proceeding distally to proximally. The galea is reapproximated with strong absorbable suture, and the skin is closed with clips and nonabsorbable suture. The anterior or leading edge of the flap is deepithelialized to be placed under the corresponding overlying edge of the frontal scalp. This technique permits the hairs from the flap to grow through the incision scar.