Importance: Rural and regional general surgeons are faced with a myriad of cutaneous lesions. The scalp presents a particularly difficult area that does not always permit primary closure. Aims: 1.To demonstrate the use of scalp rotation flaps for skin lesions that do not facilitate primary closure. 2.To describe the skill to perform complex rotational flaps in a regional setting performed by general surgeons. Methodology: Retrospective analysis of fifty consecutive large scalp rotation flaps for a variety of lesions, predominantly malignant treated by a single general surgeon in a rural healthcare service in Victoria. Results: Primary closure was achieved in 49 out of the 50 rotation flaps performed. There were no intraoperative complications. Adequate oncological clearance was gained in all cases. There were no flap losses, haematoma or skin necrosis and no procedures needed revision for involved margins. Conclusion: Rotational flaps for scalp lesions that are not amenable to primary closure can be performed by the regional general surgeon who does not have readily available access to plastic surgical services. The techniques are easily learnt and provide excellent results.