TY - JOUR
T1 - The Hatchet Flap for Eyelid and Midfacial Reconstruction
T2 - Experience from 70 Cases
AU - Custer, Philip L.
AU - Maamari, Robi N.
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Purpose: 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. Methods: 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. Results: 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 cm2(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. Conclusions: 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.
AB - Purpose: 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. Methods: 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. Results: 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 cm2(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. Conclusions: 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.
UR - http://www.scopus.com/inward/record.url?scp=85182957081&partnerID=8YFLogxK
U2 - 10.1097/IOP.0000000000002499
DO - 10.1097/IOP.0000000000002499
M3 - Article
C2 - 37581878
AN - SCOPUS:85182957081
SN - 0740-9303
VL - 40
SP - 43
EP - 48
JO - Ophthalmic plastic and reconstructive surgery
JF - Ophthalmic plastic and reconstructive surgery
IS - 1
ER -