Hatchet Flap Research Articles

Hatchet flap for distal fingertip amputations

Purpose- Fingertip amputations are responsible for significant pain, suffering, discomfort as well as lost productivity and financial and physical hardship. Distal finger tip amputations pose a unique reconstructive challenge as the aim is to provide a supple cover with sensation. Wide variety of options are available for the reconstruction following fingertip amputations. This study evaluates the use of hatchet flap in the management of distal fingertip amputations. MethodsThe hatchet flap was done in 35 fingers of 31 patients with fingertip amputations at the level of distal phalanx who presented to our unit, fulfilling the inclusion criteria during a period of 18 months. All transverse and dorsal oblique amputations (of any size) at the level of distal phalanx of any age group were included in the study. Volar fingertip amputations at the level of distal phalanx and fingertip amputations associated with other injury over the volar aspect of finger were excluded from the study. ResultsThe flap provided a very good padded soft tissue cover with good aesthetic shape to the finger tip. The scars were unnoticeable with an average 2 point discrimination of 6.7 ​mm at 12 weeks post operatively. Paresthesia was noted maximally at 1 week post operative duration. Joint stiffness was not noted in any patient. Most patients were able to return back to their normal daily routine at around 3 weeks. Complete flap necrosis was noted in 1 patient while partial tip necrosis was noted in 2 patients. ConclusionThe hatchet flap serves as a good local reconstructive flap option which preserves the tactile sensation and is a valuable addition to the wide armamentarium of reconstructive procedures available for treating the distal fingertip amputations.

Outcomes of Radial Forearm Free Flap Closure With Split-Thickness Skin Graft Versus Primary Closure.

This study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flap (RFFF) donor site. Patients with RFFF (2015-2020) were retrospectively identified. Those willing to participate in patient-reported outcomes (PRO) filled out Patient-Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHOQ). 198 patients met our inclusion criteria and 81 participated in PRO. There was a higher rate of tendon exposure in STSG versus hatchet flap (11 vs. 1, p = 0.0019), but a lower rate of skin necrosis (5 vs. 16, p = 0.0190) and epidermolysis (1 vs. 12, p = 0.0028). Scar quality in STSG was superior to hatchet flap in all domains of POSAS. MHOQ scores were similar between both groups with no statistical difference in overall scores (p = 0.2165). STSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure. 3 Laryngoscope, 134:4266-4273, 2024.

Long-Term Comparison of Esthetic Outcomes Between Hatchet and Transposition Flaps in Facial-Defect Reconstruction.

Transposition flaps are commonly used for facial-defect repair after wide excision of skin cancers. However, such repair often causes excessive tension at the donor site that can result in distortion of the adjacent area. The hatchet flap, a rotation-advancement flap, can prevent distortion by redistributing the donor site tension evenly to the recipient site. This study aims to compare the esthetic outcomes of the hatchet flap and transposition flap in facial-defect reconstruction. We retrospectively included 50 patients who underwent facial reconstruction with the hatchet flap or transposition flap after excision of skin cancer. They were followed up for more than 6months. At the last follow-up visit, the esthetic outcome was evaluated by subjective and objective assessments using the patients and observer scar assessment scale and Manchester scar scale. Thirty patients and 20 patients underwent reconstruction using the hatchet flap and the transposition flap, respectively. The total score from the patient and observer scar assessment scale was significantly lower in the hatchet flap group compared with the transposition flap group (p = 0.009). The Manchester scar scale showed a total score of 7.67 ± 2.2 for the hatchet flap and 9.95 ± 1.99 for the transposition flap: in the color (p < 0.001), distortion (p < 0.001), and texture (p < 0.02) categories, the hatchet flap yielded significantly better outcomes than the transposition flap. The hatchet flap had good esthetic outcome for facial reconstruction and could be a valuable option for reconstructing facial defects. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

The Tree Flap: A Novel Modification of the Hatchet Flap for Lower One-third Nasal Reconstruction.

Nasal reconstruction after skin cancer excision has routinely been challenging without any aesthetic sequelae, and any defects on the nose are readily noticeable. To circumvent this problem, surgeons have developed different flap techniques to mobilize adjacent tissue to repair aesthetically sensitive defects. We describe our experience, outcomes, and valuable tips for using the "tree flap," a novel modification of the hatchet flap that extends the back cut to significantly increase mobility, leaving only a small skin paddle to maintain perfusion to the flap. The combination of undermining, a rotatory component, and minimal skin attachment allows radical mobility without compromising blood supply. Thus, the tree flap allows for reconstruction of defects of the dorsum of the nose and defects near the nasal tip with ease, given both advancement and rotational movements. Compared with other local flaps such as the shark pedicle flap or bilobed flap, the tree flap has a similar learning curve, minimal donor site morbidity, and equivalent aesthetic outcome. It may be used to repair larger defects that may not be amenable to the bilobed flap as an alternative to a full-thickness skin graft. In our experience, the tree flap also has the advantage of a lower rate of pin cushioning when compared with other options such as the bilobed flap. The tree flap has great mobility and is a reliable option for reconstruction of the lower one-third of the nose with excellent aesthetic results and minimal complications.

Modified Reverse Hatchet Flap for Ablepharon-Macrostomia Syndrome.

Ablepharon-macrostomia syndrome is a rare disorder characterized by TWIST2 mutations and anterior lamellar dysgenesis. Timely intervention is critical to prevent exposure keratopathy, corneal ulceration, and permanent vision loss. We report a novel approach to multiplanar eyelid reconstruction in ablepharon-macrostomia syndrome involving use of a modified reverse hatchet flap in 1 lower eyelid along with division at the eyelid margin, recession of the eyelid retractors in conjunction with preputial skin grafting for anterior lamellar restoration in the other 3 eyelids.

The Hatchet Flap for Eyelid and Midfacial Reconstruction: Experience From 70 Cases.

To describe surgical variations of the hatchet flap and a large series of patients in which this procedure was used for eyelid and midfacial reconstruction. A retrospective review was performed on patients treated with a hatchet flap between March 2016 and March 2023. Patient demographics, defect characteristics, surgical techniques, and outcomes were investigated. The hatchet flap was used to repair 70 defects in 69 patients, aged 41.6 to 90.0 years (mean, 66.1). Defects measured 0.6 to 23.6 cm 2 (mean, 4.8) and resulted from Mohs surgery (n = 62), exenteration (n = 2), benign lesion excision (n = 3), or cicatricial ectropion/fistula repair (n = 3). The flap tail was managed with 3 techniques: V-Y plasty (n = 26), transposition (n = 34), and excision (n = 10). Ancillary procedures were often used during reconstructions (skin grafts: 29; double hatchet flap: 2; additional skin flaps: 26; tarsoconjunctival flaps: 6; and other grafts: 7). Small distal eschars healed in 7 flaps without necrosis. Four patients with subcutaneous thickening improved after steroid injections. Mild hatchet flap contracture may have contributed to postoperative cicatricial ectropion in 1 patient. There were no other flap related complications. In selected patients, the hatchet flap is a versatile technique to mobilize vascularized tissue into eyelid/midfacial defects resulting from the excision of lesions or treatment of cicatricial ectropion/fistulas. Individuals without laxity in the plane perpendicular to the flap base may not be good candidates for this procedure. The hatchet flap can be modified by advancing, transposing, or excising the flap tail. Reconstruction is often combined with other flaps/grafts. Few complications were associated with the hatchet flap.

Double Hatchet Flap for the Reconstruction of a Posterior Neck Soft Tissue Defect due to Surgical Site Infection After Posterior Cervical Spine Surgery

Double Hatchet Flap for the Reconstruction of a Posterior Neck Soft Tissue Defect due to Surgical Site Infection After Posterior Cervical Spine Surgery

Double hatchet flap for scalp defect reconstruction. A case report

Double hatchet flap for scalp defect reconstruction. A case report

Double hatchet flap as adequate dermatosurgical approach for tumours of the occipital scalp zone: Presentation of two cases.

Tumors of the scalp remain a serious challenge for clinicians since poor locoregional skin elasticity hinders the ability to utilise certain flaps, limiting the choice of reconstructive techniques available. As a result, surgical restoration of medium to large-sized defects are left to the discretion of the surgeon, who with a comprehensive knowledge of restorative techniques, along with the advantages, limitations as well as a sound understanding of the locoregional anatomy, can make thorough decisions on the choice of which flap is best suited for the defect. Here we present two cases where the double hatchet flap was employed as a dermatosurgical approach in order to provide exceptional cosmetic results. On dermatological examination, both patients presented with a medium to large- sized tumour formation but were otherwise in good health. Both underwent radical, widelocal excision, followed by reconstructive manipulation in the form of a double hatchet flap to close the defect. Postoperative follow- up reported positive signs of wound healing with aesthetically pleasing results. Finally, we discuss the use of various flaps in such conditions while providing evidence for the double hatchet flap as a possible alternative that provides perfect aesthetic results as seen in our cases. Such a complex surgical intervention requires the expertise of a multidisciplinary team in order to achieve an overall successful outcome.

Glabellar Hatchet Flap for Reconstruction of the Nasal Dorsum – A Case Report

Reconstruction of nasal defects presents a challenge for the reconstructive surgeon due to the complicated aesthetic subunits of the nose and limited available adjacent mobile skin with varying color, texture, and thickness. The ideal tissue needs to be of similar color, texture, and thickness to that of the defect. The glabellar flap is the ideal flap for closure of proximal nasal dorsal defects. Here, we present a case of a soft tissue defect in the proximal third of the nasal dorsum which was resurfaced with the glabellar hatchet flap.

Random pattern hatchet flap as a reconstructive tool in the treatment of pressure sores: clinical experience with 36 patients.

Pressure sores represent a reconstructive challenge, and the high recurrence rate and need for reoperations should always be considered. Sacrifice of muscle and fascia in primary reconstruction may compromise options for future repairs. The objective of this study was to evaluate the reliability of muscle- and fascia-sparing random pattern hatchet flap reconstruction of pressure sores in different body regions. From November 2017 to December 2019, 36 participants with grade III and IV pressure sores underwent random pattern hatchet flap reconstruction. Early postoperative complications and flap survival were evaluated in follow up for 6-12 months. Thirty-six participants with an age range of 15 to 67 years who presented with pressure sores (13 sacral, 12 ischial, 10 trochanteric, and 1 scapular) underwent surgery. Complete healing of sores was observed within 21 days of surgery in 32 cases and within 30 days for the remaining four cases. Postoperative complications (11.2%) were recorded in only four participants: two experienced partial wound dehiscence, one seroma developed in a trochanteric case, and there was one infection in a sacral sore. Random pattern hatchet flap is a reliable tool that results in minimal complications for treatment of pressure sores of limited dimensions.

Scalp Reconstruction with Novel Unopposing Double Hatchet Flaps- A Case Series

Though there are regional and distant approaches for acquired scalp defect reconstruction, use of local flaps always have the advantage of retaining the topography of scalp. As in treatment of any other defect the choice of a local flap in scalp wound coverage is dictated by the location, size, and depth of the defect and by the availability of adjacent tissue for reconstruction. The versatile and adaptable triangular hatchet flap with a partial skin and subcutaneous bridged pedicle has great versatility. When used singularly or in pair to cover small and medium sized defects, utilising both rotation and advancement components for its movement, has the benefit of maintaining cosmetic appearance. Double hatchet flaps are used commonly in an opposing manner so as to convert a circular wound to a ‘S’ shaped suture line. In the current case series, with a description of four representative cases, authors have presented a modification of this double hatchet flap in unopposing configuration instead of an opposing pattern to cover scalp defects when the type and extent of injury affecting the scalp prevents in heaving flaps at 180 degree to each other. Authors opine that this technique adds into the ever expanding armamentarium of reconstructive surgeon and can be made use of in the aforementioned conditions wherein the standard pattern cannot be employed to cover moderate sized scalp defects.

How We Do It: The Glabellar Hatchet Flap for Reconstruction of the Proximal Nasal Side Wall and Medial Canthus.

How We Do It: The Glabellar Hatchet Flap for Reconstruction of the Proximal Nasal Side Wall and Medial Canthus.

Retalho “em Machado” de Emmett

INTRODUÇÃO: O retalho “em machado” de Emmett é um retalho cutâneo local, triangular (unilateral ou bilateral) e predominantemente de rotação que permite encerrar defeitos de pequenas, médias e grandes dimensões em diversas áreas cutâneas.MATERIAL E MÉTODOS: Quatro homens com idade média de 78,8 anos foram submetidos à exérese alargada de cancro cutâneo não melanoma (um carcinoma basocelular da face e do couro cabeludo, um porocarcinoma da face e um fibroxantoma atípico do couro cabeludo), sob anestesia local, seguido de reconstrução com o retalho “em machado” de Emmett.RESULTADOS: O diâmetro médio dos defeitos cirúrgicos foi de 30 mm. O retalho "em machado” de Emmett de triângulo bilateral foi usado num e o de triângulo unilateral nos restantes três casos. Não se registaram complicações pós-operatórias. Os resultados funcionais e estéticos foram muito aceitáveis. Os doentes não apresentavam recidiva aos 12 meses de seguimento.CONCLUSÃO: O retalho "em machado” de Emmett mostrou ser um procedimento alternativo versátil, seguro e eficaz nos quatro doentes.

Hatchet Flap With Transposed Nasal Inset for Midfacial Reconstruction

The purpose of this study is to report the surgical technique and functional outcomes of the hatchet flap with transposed nasal inset for midfacial defect repairs. An Institutional Review Board-approved, retrospective review was performed to identify patients treated using the hatchet flap with transposed nasal inset. Patient demographics, disease etiology, defect characteristics, and postoperative complications were collected from preoperative and follow-up visits. The hatchet flap with transposed nasal inset was performed in 5 patients between March 2016 and April 2017. Two patients developed mild transient ischemia of the nasal inset flap tip without necrosis. A suture granuloma was removed in 1 patient. No additional surgical procedures were required after the nasal inset cheek flap. The hatchet flap with transposed nasal inset is an effective procedure to address defects involving the upper cheek, lower eyelid, and medial canthus. Incorporation of the nasal inset helps prevent distortion of the ala and facilitates closure of the flap donor site. This technique may be employed in certain patients as an acceptable alternative to more extensive Mustardé or paramedian forehead flaps.

Perforator plus hatchet flap for salvage of donor site complication following cross finger flap: A case report

Cross finger flaps are commonly used flap for the reconstruction of soft tissue defects involving the fingers and thumb. Following reconstruction by cross finger flap, the donor area is usually addressed with split thickness or full thickness skin graft. When considering the benefits of cross finger flap to other reconstructive options, cross finger flap seems to be the most common option in plastic surgeons’ armamentarium. Complications in the donor area due to infection or inflammation are uncommon as the hand being a highly vascular structure. We present a case of cross finger flap with graft loss in the donor area as a complication, salvaged by a perforator plus flap incorporated in the hatchet flap. There were not any complications following the salvage procedure. Hyperbaric oxygen therapy was used as an adjunct for a salvage procedure.

Reconstruction of Small to Moderate Size Peri-Auricular Skin Defects Using Hatchet Flaps

Reconstruction of Small to Moderate Size Peri-Auricular Skin Defects Using Hatchet Flaps

Intraoperative local flap transforming (iLoFT) method; from hachet to reading-man flap

Local flaps are widely used in soft tissue reconstruction because they result in good colour and texture match. They can be quickly placed without donor site morbidity. However, it is not always easy to preoperatively design a feasible procedure, predict the final scar line or image the tension that may occur on and around the flap, especially for inexperienced surgeons. Because the elasticity of the skin varies with anatomical location and among individuals, unpredictable intraoperative design changes are sometimes required. Therefore, a preoperative back-up plan would be helpful. We evaluated the possibilities and advantages of an intraoperative switch from a hatchet flap (HF) to a reading man flap (RMF) procedure. Using a previously reported computer simulation with the finite element method (FEM) analysis, we developed an intraoperative local flap transformation (iLoFT) model.

Clinical Experience With the Combination of a Biceps Femoris Muscle Turnover Flap and a Posterior Thigh Fasciocutaneous Hatchet Flap for the Reconstruction of Ischial Pressure Ulcers.

The reconstruction of ischial pressure ulcers is problematic because of the distinctive anatomical properties of the region and high recurrence rates. To date, no single technique has been proven to be effective in reducing recurrence of the ulcers. We present our experience with the combination of a biceps femoris muscle turnover flap and a posterior thigh fasciocutaneous hatchet flap and discuss the long-term results. A retrospective clinical analysis of 15 patients with grade 4 ischial pressure ulcers reconstructed with biceps femoris muscle turnover flaps and laterally based posterior thigh fasciocutaneous hatchet flaps was carried out between January 2010 and January 2013. Debridement and reconstruction of the ulcers were accomplished in a single stage. The posterior thigh fasciocutaneous flap was elevated in a hatchet style. The long and/or short head of the biceps femoris muscle were dissected from their insertions, turned over on their major pedicles, and their distal portions were used to obliterate the cavitary defect. The skin defect over the muscles was covered by the fasciocutaneous hatchet flap. The average age of the patients was 42.6 years and the mean follow-up time was 27.2 months. Three patients had the following early postoperative complications: hematoma, suture dehiscence, and the necrosis of the short head of biceps muscle. Only 1 patient had a recurrent ulcer 15 months after surgery, which was treated with debridement and the readvancement of the fasciocutaneous flap. The overall recurrence rate was 6.6%. The biceps femoris muscle turnover flap combined with the posterior thigh fasciocutaneous hatchet flap is a worthwhile option to consider for the reconstruction of ischial pressure ulcers and this technique produces favorable results in terms of the lack of recurrence and complications. The use of the muscle and fasciocutaneous tissue as 2 different flaps, which have different roles in the early and late postoperative period, reduces the recurrence rate.

Hatchet flap and rotation flap for distal dorsal finger defect reconstruction.

Hatchet flap and rotation flap for distal dorsal finger defect reconstruction.