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).
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The Double Hatchet Flap: A Workhorse in Head and Neck Local Flap Reconstruction
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