A double triangular flap, or hatchet flap, with a partial cutaneous pedicle, has great versatility for facial reconstruction, yet there has been little published discussion regarding the potential applications and/or modifications of the flap. A total of 483 cutaneous malignant neoplasms have been excised and repaired by the senior author (C.C.M.) using a modified bilateral hatchet flap; 366 of the neoplasms were located in the head and neck region. The flap has been used to reconstruct defects in the scalp, eyebrow, lower eyelid, nasal tip, cheek, chin, arms, and torso, with no cases of flap loss. The design of the flap and our modification will be discussed in detail, along with a description of 4 representative cases.
Depiction of the design of the double hatchet flap.
Squamous cell carcinoma of the scalp (A) with double hatchet flap incised after primary excision (B), immediately after closure (C), and 6 months after surgery (D).
Double hatchet flap in the lateral aspect of the brow. Invasive basal cell carcinoma in the lateral aspect of the left side of the brow (A). The skin flaps were designed and elevated (B). When seen both immediately after closure (C) and 2 months after surgery (D), there was no elevation of the brow.
Double hatchet flap in the lateral facial region. Defect after excision of invasive basal cell carcinoma in the lateral facial region (A). The double hatchet flap was then used to close the defect, as seen immediately (B and C) and 7 months (D) after surgery.
The double hatchet flap is used for reconstruction after radiation therapy for basal cell carcinoma of the forehead. The flap is designed for use after failure of radiotherapy for basal cell carcinoma of the forehead (A). The flaps are loosely approximated after ablation (B) and after complete closure (C). A satisfactory result is seen 6 months after surgery (D).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Facial Plastic Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
The Double Hatchet Flap: A Workhorse in Head and Neck Local Flap Reconstruction
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.