Reconstruction of Scalp Defects with Rotational Flaps: Where Is the Limit?

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

See attached text

Comments for author File: Comments.pdf

Author Response

1. This article refers a wide experience done by authors reconstructing a variety of scalp defects by means of rotational flaps with excellent results.. Authors’ choice is to propose the rotational flap as a solution of defects ranging up to 9 centimeters in diameter located in all the extension of the scalp; on this purpose they propose an algorithm included in the paper.

Thank you for your time and effort to review our manuscript.

2. Concerning the Introduction paragraph the superiority of the rotational flaps to other local flaps is stated without any reference, and this is surprising.

Thank you for pointing this out. We added 3 relevant references in the Introduction.

3. No remarks on the Material and Methods and Result paragraphs.

Thank you again for reviewing our manuscript.

4. In the Discussion paragraph again the superiority of the rotational flaps needs some more in deep analysis, because there is no consensus about it. Indeed on this subject really a lot papers have been published and my impression is that the bibliographic references cited by Authors fail to be exhaustive, at least in the case of burns and electrical injuries.

Thank you for pointing this out. We amended the Discussion, adding a paragraph (lines321-328) and 3 refs on burns and electrical injuries. 

The Discussion focuses on the traits of rotational flaps, and the surgical maneuvers to broaden their use and improve our results consistently, while the proposed algorithm provides insights into the flexibility of this flap. We have tried in this technical manuscript to give a balanced and modern view of a well-known flap, based on our experience, and illustrate this view with numerous figures and surgical outcomes. 

Reviewer 2 Report

Comments and Suggestions for Authors

I would like to thank the authors for their efforts in carrying out this study. The use of rotation flaps to reconstruct scalp defects is a technique that is already widely described in the literature. For this reason, the originality of the article is limited. However, I believe that in view of the large sample size it may find its place for publication. The study seems to be well described but the English needs revision by a native speaker. I also suggest minor corrections:

• Since the novelty of the topic seems to be low, I suggest that the authors include something to distinguish their study from previously published ones.
• the study design is unclear and should be explicitly stated in the materials and methods sections (retrospective or prospective? the database is stated to be prospective, but the design of the study appears to be retrospective observational)
• line 90: what kind of anestetic solution was used? did it contain adrenalin?
• In table 1 there are abbreviations that should be included in the table legend. What is meant by ‘other skin cancer’. As the sample size is large, I suggest only including the mean scores and not the median.

Comments on the Quality of English Language

The study seems to be well described but the English needs revision by a native speaker

Author Response

1. I would like to thank the authors for their efforts in carrying out this study. The use of rotation flaps to reconstruct scalp defects is a technique that is already widely described in the literature. For this reason, the originality of the article is limited. However, I believe that in view of the large sample size it may find its place for publication. The study seems to be well described but the English needs revision by a native speaker. I also suggest minor corrections:

Thank you for your time and effort to review our manuscript and your kind words for our work. The text has been thoroughly revised by a native speaker, improving the readability, and thus the quality of this paper.

2. Since the novelty of the topic seems to be low, I suggest that the authors include something to distinguish their study from previously published ones.

We agree, and thus we proposed a very detailed algorithm, based on several parameters, that provides novelty, and distinguishes us from other studies.

3. the study design is unclear and should be explicitly stated in the materials and methods sections (retrospective or prospective? the database is stated to be prospective, but the design of the study appears to be retrospective observational)

Thank you for pointing this out. We added the relevant information in the Methods section.

4. line 90: what kind of anestetic solution was used? did it contain adrenalin?

Thank you for this question. In line 91, there are 2 relevant references, regarding the anesthetic solution (it contains adrenaline)

5. In table 1 there are abbreviations that should be included in the table legend. What is meant by ‘other skin cancer’. As the sample size is large, I suggest only including the mean scores and not the median.

Thank you again for your comments. We added the relevant abbreviations.

Other skin tumors indicate more rarely encountered lesions, apart from BCC,SCC and MM (e.g. Merkel cell, dermal sarcoma, atypical fibroxanthoma, etc). We had only 4 such cases, and thus we did not include this information, as irrelevant to the purpose of this study.

The mean and standard deviation was used for all continuous variables. However, the use of the median adds further information and enables the Readership to compare directly the values between the mean and median for this large sample size.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I am satisfied of the proposed revision that is, in my opinion, suitable for publication.