Multiple Pin Wheel Flaps and Its Modification in Special Areas of the Scalp

Closure of the defects in special areas of the scalp, such as forehead, above the ear and occipital protuberance produces distortion of the hairline, lifting of the eyebrow, lengthy scars and distortion of the ear. The treatment of this distortion presents a challenge, for which we had a very favorable response with modification of the original four flap closure in a pinwheel fashion as described by TR Vecchione. In our series of eight cases, five flaps were marked at various convenient degrees instead of four flaps as originally described. In scalp defects in and around the hairline the length of the five flaps results in a smaller scar, without changing the hairline, lifting the eyebrow or distorting the position of the pinna.