The study aimed to estimate the incidence of flap dehiscence and/or necrosis (FD/N) following standard rotational flap (SRF) surgery for cranial vault osteomyelitis without intracranial involvement (CVO) and to identify factors associated with these complications.

A retrospective study was conducted using chart reviews of patients who underwent SRF to cover CVO defects over a 10-year period. Twenty-one predictor variables were analysed, categorised into demographic, health status, anatomic, and surgical factors. The primary outcome was the occurrence of FD/N. Descriptive, bi- and multivariate regression analyses were used to identify variables significantly associated with FD/N (P ≤ 0.05).

The study included 154 subjects who underwent SRF (26.6 % female), with a mean age of 75.6 ± 12.8 years (range, 26–94). The incidence of FD/N was 5.2 %. Multivariate analysis revealed that smoking (odds ratio [OR] 1.07; P = 0.04), second surgery (OR 1.18; P < 0.001), compromised scalp vascularity (OR 1.1; P = 0.007), and defects at the central scalp and vertex (OR 1.08; P = 0.02) were statistically significantly associated with an increased risk of FD/N.

FD/N is an infrequent complication following SRF for CVO. Significant modifiable risk factors included smoking, multiple flap operations, compromised scalp vascularity, and defects at the central scalp and vertex. Addressing these factors may help reduce the risk of FD/N in this patient population. Future research should investigate outcomes among different flap types for CVO defects.