Hatchet Flap

Abstract

Hatchet rotation-advancement flap is a well-known flap design, which is a worthwhile option in the reconstruction of lateral nasal region skin defects. In this study, the author's experience with 3 different designs of hatchet flaps, for the reconstruction of the defects in 3 different parts of the lateral nasal region, has been presented. All flaps in 31 clinical cases were planned from the cheek and nasolabial region. For the defects in the upper 1/3 part, flaps were planned in advancement type, for the middle 1/3 part, flaps were planned in rotation-advancement type, and for the lower 1/3 part, flaps were planned in rotation type. Satisfactory results were achieved in all patients except in patients having defects in the lower 1/3 part. In reconstruction of lateral nasal region defects, hatchet flap has different advantages such as versatility, better tissue match, and short final scar in the nasolabial fold. When planned in rotation type, for the lower 1/3 part, the ratio of complications increases significantly, which necessitates considering other flap options as the first-line choice of reconstruction for this region.

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

“…Like the hatchet flap, our flap follows the nasolabial fold to avoid blunting of the nasal alar groove and hides the resulting scar within the nasolabial fold to achieve better cosmesis. 7 With the combination of extensive undermining, a rotatory component, and very minimal skin attachment, the skin flap can be mobilized radically without compromising blood supply, as shown in Figure 1 . Unlike a V-Y flap, it can also be used to comfortably reach and repair defects approaching the nasal tip, or defects more closely positioned to the alar rim in the lower one-third of the nose.…”

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

“…Several authors have noted that unlike procedures such as the paramedian forehead flap, the hatchet flap mobilizes skin adjacent to the defect, providing an excellent tissue match. 7,8 Periocular Mohs defects are often irregular in shape and involve different anatomic regions. We frequently augmented the hatchet flap with eyelid skin grafts, either for improved tissue match or if the flap was inadequate to fit the size or shape of the wound.…”

“…6 Likewise, Ceran et al did not observe tissue loss after repair of 31 lateral nasal defects with largest dimension of 1.2 to 2.5 cm. 7 Pan et al describe using the hatchet flap to repair 5 periocular defects with greatest dimension of 1.0 to 2.2 cm. 8 Many (41.8%) of the wounds in the present study were 3.0 to 6.0 cm in width, larger than the eyelid and midfacial defects reported above.…”

“…In many patients, it is possible to place the distal portion of the curvilinear incision in the nasolabial (melolabial) fold, effectively hiding the resultant scar. 6,7 A cut-back can be made in the alar groove, allowing transposition of the tail to reduce lateral traction and displacement of the ala. 3 While in most published reports, the hatchet flap tail is advanced in a V-Y method, we also commonly used this transposition technique. Both Emmett and Lewin have commented that this tail Z-plasty increases the ability to rotate the flap toward the wound.…”