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

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.