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Erschienen in: European Journal of Plastic Surgery 5/2012

01.05.2012 | Original Paper

The versatility of the hatchet flap in soft tissue reconstruction and a proposed new classification

verfasst von: Ahmed Elshahat

Erschienen in: European Journal of Plastic Surgery | Ausgabe 5/2012

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Abstract

The Hatchet flap is a well-known flap used to cover round defects with primary closure of the donor sites in a V–Y fashion. This provides a stable coverage of the defect by a skin flap from the adjacent area and thus having similar color, texture, and sensation to the lost skin. Literature showed the application of the hatched flaps in facial, fingertip, pressure sores, and meningomyelocele reconstruction but not in the other anatomic areas. The aim of this study was to demonstrate the versatility and reliability of two types of hatchet flaps to reconstruct soft tissue defects at various anatomical regions of the body. Forty-six hatchet flaps were used in 40 patients to reconstruct defects located at scalp, face, neck, chest, axilla, back, sacrum, trochanter, genitalia, perineum, buttock, thigh, knee, foot, and fingertip. The causes of defects were infection, trauma, tumor excision, pressure necrosis, congenital meningomyelocele, chemical burn, and radiation. Mean follow-up period was 6.6 months. Hatchet type I flaps were advanced without undermining using the viscoelastic properties of the skin, while hatchet type II flaps were undermined before rotation advancement. All defects were successfully covered. The flaps survived completely. Partial dehiscence occurred at the donor site of three flaps but healed without problems after re-suturing. In conclusion, hatchet flaps are versatile flaps that provide a simple but efficient solution to defects of different etiologies located at different anatomical regions in the body. Minimal blood loss and short duration of surgery make them first option flaps for patients with co-morbidities.
Literatur
1.
Zurück zum Zitat Jackson IT (2007) Forehead reconstruction. In: Jackson IT (ed) Local flaps in head and neck reconstruction, 2nd edn. Quality Medical, St. Louis, pp 47–100 Jackson IT (2007) Forehead reconstruction. In: Jackson IT (ed) Local flaps in head and neck reconstruction, 2nd edn. Quality Medical, St. Louis, pp 47–100
2.
Zurück zum Zitat Emmett AJ (1977) The closure of defects by using adjacent triangular flaps with subcutaneous pedicles. Plast Reconstr Surg 59:45PubMedCrossRef Emmett AJ (1977) The closure of defects by using adjacent triangular flaps with subcutaneous pedicles. Plast Reconstr Surg 59:45PubMedCrossRef
3.
Zurück zum Zitat Reynaud JP (1983) Hatchet flap for the repair of cutaneous excisions on the nose. Ann Chir Plast Esthet 28:369PubMed Reynaud JP (1983) Hatchet flap for the repair of cutaneous excisions on the nose. Ann Chir Plast Esthet 28:369PubMed
4.
Zurück zum Zitat Horwath H, Roscic I, Falkensammer G, Engleder R (1989) Hatchet-form flap as a method of aesthetic reconstruction of the nose. Fortchr Kiefer Gesichtschir 34:151 Horwath H, Roscic I, Falkensammer G, Engleder R (1989) Hatchet-form flap as a method of aesthetic reconstruction of the nose. Fortchr Kiefer Gesichtschir 34:151
5.
Zurück zum Zitat Baron JL, Reynaud JP, Gary-Bobo A, Maya M (1990) Specificity of hatchet flaps in the laterofacial region. Ann Chir Plast Esthet 35:47PubMed Baron JL, Reynaud JP, Gary-Bobo A, Maya M (1990) Specificity of hatchet flaps in the laterofacial region. Ann Chir Plast Esthet 35:47PubMed
7.
Zurück zum Zitat Pan Y, Ai Y, Li H, Guo S (2004) Local hatchet flap for facial skin defects reconstruction in special areas. Dermatol Surg 30:1256PubMedCrossRef Pan Y, Ai Y, Li H, Guo S (2004) Local hatchet flap for facial skin defects reconstruction in special areas. Dermatol Surg 30:1256PubMedCrossRef
8.
Zurück zum Zitat Gargano F, Alfano C (2005) Versatility of the hatchet flap in facial reconstruction. Acta Chir Plast 47:67PubMed Gargano F, Alfano C (2005) Versatility of the hatchet flap in facial reconstruction. Acta Chir Plast 47:67PubMed
10.
Zurück zum Zitat Quillot M, Lodde JP, Pegorier O, Reynaud JP, Cormerais A (1994) A variant of island flaps for the covering of pressure sores: the hatchet flap: a props of 31 cases. Ann Chir Plast Esthet 39:469PubMed Quillot M, Lodde JP, Pegorier O, Reynaud JP, Cormerais A (1994) A variant of island flaps for the covering of pressure sores: the hatchet flap: a props of 31 cases. Ann Chir Plast Esthet 39:469PubMed
11.
Zurück zum Zitat Josvay J, Donath A (1999) Modified hamstring musculocutaneous flap for the coverage of ischial pressure sores. Plast Reconstr Surg 103:1715PubMedCrossRef Josvay J, Donath A (1999) Modified hamstring musculocutaneous flap for the coverage of ischial pressure sores. Plast Reconstr Surg 103:1715PubMedCrossRef
12.
Zurück zum Zitat Demirseren ME, Gokrem S, Ozdemir OM, Katircioglu A, Can Z, Serel S (2003) Hatchet-shaped tensor fasciae latae musculocutaneous flap for the coverage of trochanteric pressure sores: a new modification. Ann Plast Surg 51:419PubMedCrossRef Demirseren ME, Gokrem S, Ozdemir OM, Katircioglu A, Can Z, Serel S (2003) Hatchet-shaped tensor fasciae latae musculocutaneous flap for the coverage of trochanteric pressure sores: a new modification. Ann Plast Surg 51:419PubMedCrossRef
13.
Zurück zum Zitat Josvay J, Sashegyi M, Kelemen P, Donath A (2006) Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores. J Plast Reconstr Aesthet Surg 59:137PubMedCrossRef Josvay J, Sashegyi M, Kelemen P, Donath A (2006) Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores. J Plast Reconstr Aesthet Surg 59:137PubMedCrossRef
14.
Zurück zum Zitat Schwabegger AH, Delfrari B, Apprich C (2006) Pedicled deltoid hatchet flap for treatment of pressure sore at the shoulder. Eur J Plast Surg 28:534CrossRef Schwabegger AH, Delfrari B, Apprich C (2006) Pedicled deltoid hatchet flap for treatment of pressure sore at the shoulder. Eur J Plast Surg 28:534CrossRef
15.
Zurück zum Zitat Josvay J, Bognar L (2003) Large lumbosacral meningomyelocele closure with gluteus maximus musculocutaneous hatchet flap. Eur J Plast Surg 25:378 Josvay J, Bognar L (2003) Large lumbosacral meningomyelocele closure with gluteus maximus musculocutaneous hatchet flap. Eur J Plast Surg 25:378
16.
Zurück zum Zitat Tuncali D, Barutcu AY, Gokrem S, Terzioglu A, Aslan G (2006) The hatchet flap for reconstruction of fingertip amputations. Plast Reconstr Surg 117:1933PubMedCrossRef Tuncali D, Barutcu AY, Gokrem S, Terzioglu A, Aslan G (2006) The hatchet flap for reconstruction of fingertip amputations. Plast Reconstr Surg 117:1933PubMedCrossRef
17.
Zurück zum Zitat Josvay J, Sashegyi M, Kelemen P, Donath A (2005) Clinical experience with the hatchet-shaped gluteus maximus musculocutaneous flap. Ann Plast Surg 55:179PubMedCrossRef Josvay J, Sashegyi M, Kelemen P, Donath A (2005) Clinical experience with the hatchet-shaped gluteus maximus musculocutaneous flap. Ann Plast Surg 55:179PubMedCrossRef
18.
Zurück zum Zitat Hayashi A, Maruyama Y, Saze M, Okada E (1998) The lateral thigh V–Y flap for repair of ischial defects. Br J Plast Surg 51:113PubMedCrossRef Hayashi A, Maruyama Y, Saze M, Okada E (1998) The lateral thigh V–Y flap for repair of ischial defects. Br J Plast Surg 51:113PubMedCrossRef
19.
Zurück zum Zitat Gillies H, Millard DR (1957) The principles and art of plastic surgery. Little, Brown, Boston Gillies H, Millard DR (1957) The principles and art of plastic surgery. Little, Brown, Boston
20.
Zurück zum Zitat Limberg AA (1946) Mathematical principles of local plastic procedures on the surface of the human body. Government Publishing House for Medical Literature, Medgiz, Leningrad, Quoted from reference 1 Limberg AA (1946) Mathematical principles of local plastic procedures on the surface of the human body. Government Publishing House for Medical Literature, Medgiz, Leningrad, Quoted from reference 1
21.
Zurück zum Zitat Dufourmentel C (1962) La fermeture des pertes de substance cutanee limitees. Le lambeau de rotation en L pour losange, dit “LLL”. Ann Chir Plast 7:61 Dufourmentel C (1962) La fermeture des pertes de substance cutanee limitees. Le lambeau de rotation en L pour losange, dit “LLL”. Ann Chir Plast 7:61
22.
23.
Zurück zum Zitat Esser FJS (1917) Island flaps. NY Med J 106:264 Esser FJS (1917) Island flaps. NY Med J 106:264
24.
Zurück zum Zitat Behan FC (2003) The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 73:261CrossRef Behan FC (2003) The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 73:261CrossRef
25.
Zurück zum Zitat Moncrieff MD, Thompson JF, Stretch JR (2010) Extended experience and modifications in the design and concepts of the keystone design island flap. J Plast Reconstr Aesthet Surg 63:1359PubMedCrossRef Moncrieff MD, Thompson JF, Stretch JR (2010) Extended experience and modifications in the design and concepts of the keystone design island flap. J Plast Reconstr Aesthet Surg 63:1359PubMedCrossRef
26.
Zurück zum Zitat Lockwood TE (1991) Superficial fascial system (SFS) of the trunk and extremities: a new concept. Plast Reconstr Surg 87:1009PubMedCrossRef Lockwood TE (1991) Superficial fascial system (SFS) of the trunk and extremities: a new concept. Plast Reconstr Surg 87:1009PubMedCrossRef
Metadaten
Titel
The versatility of the hatchet flap in soft tissue reconstruction and a proposed new classification
verfasst von
Ahmed Elshahat
Publikationsdatum
01.05.2012
Verlag
Springer-Verlag
Erschienen in
European Journal of Plastic Surgery / Ausgabe 5/2012
Print ISSN: 0930-343X
Elektronische ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-011-0615-9

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