Rotation flap to cover a large defect on the dorsum of the hand

The unique requirements of soft tissue coverage of the hand offer a challenge for the surgeon dealing with such defects. Local excision of such lesions may end in a defect that is not amenable to primary closure. Management of such defects requires the application of a graft or flap. We describe the application of a rotation flap for closure of a large defect on the dorsum of the hand following excision of a keratoacanthoma. The rotation flap offers repair with local skin of similar colour, texture and thickness. The end results were excellent both functionally and cosmetically.