Background: Rotation flaps are reliable pillars in reconstructive surgery that provide excellent cosmesis. They allow the recruitment of adjacent tissue with similar characteristics and redistribute tension vectors along an arcuate path to achieve low tension closure. They also readily conform to relaxed skin tension lines, resulting in good cosmesis.
Objective: To review the principles and designs of rotation flaps and provide reproducible examples for practical application by the reconstructive surgeon.
Materials and methods: Various named and anatomic site-specific rotation flaps were selected to demonstrate their versatility, and surgical pearls are provided to achieve optimal results.
Conclusions: Understanding the principles of rotation flaps is critical to reconstructive surgeons. Proper design, adequate undermining, strategic placement of standing cone deformities, and appreciation of pivotal restraint are necessary for the successful execution of rotation flaps. Mastering the application of rotation flaps will add to a surgeon's armamentarium and allow their application to other anatomic sites.  .