Reconstruction of Small to Moderate Size Peri-Auricular Skin Defects Using Hatchet Flaps | ||||
The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
Article 3, Volume 42, Issue 1, January 2018, Page 7-13 PDF (16.98 MB) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/ejprs.2018.214970 | ||||
View on SCiNiTO | ||||
Authors | ||||
Riham Lashin* ; Ahmed Elshahat | ||||
The Department of Plastic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||||
Abstract | ||||
Background: Peri-auricular region is a special anatomical area including the sideburn area anteriorly, hair superiorly, the non-hairy post-auricular sulcus posteriorly, and the mandibular angle and neck inferiorly. Reconstruction of defects affecting this area should consider all these structures so that hairy area has to be reconstructed with hairy flaps and the non-hairy area has to be reconstructed with non-hairy flaps. Local flaps in the form of hatchet type flap provide this reconstruction aim. The Hatchet flap is a well-known flap < br />used to cover round defects with primary closure of the donor sites in a V–Y fashion. Methods: Hatchet flaps have been used in reconstruction of defects in variable anatomical sites as published by the senior author and proved to be a reliable flap providing 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. Aim of Work: To describe how to utilize the hatchet flap < br />for reconstruction of small to moderate size peri-auricular skin defects in order to provide satisfactory coverage, with the best aesthetic outcome, inconspicuous scars in both the donor and recipient areas, with the least possible complications. Nine cases were presented in this study. Results: Results were good, all defects were successfully covered. The flaps survived completely, the likeness of hair color and density in the sideburn area was achieved, and the scars at the donor site were hidden in the post-auricular hairline, post-auricular sulcus were maintained and not obliterated by the flap in any of these cases. All patients were shown a satisfactory appearance, with no complications both on the recipient and donor sites. Conclusion: Hatchet flaps are a versatile and reliable technique for reconstruction of small to moderate size periauricular skin defects which provides a stable coverage of the defect, with safe vascularity of flaps, and provide an excellent cosmetic outcome. | ||||
Keywords | ||||
Reconstruction; Peri-auricular; Skin defects; Hatchet flaps | ||||
References | ||||
1- Yang Z., Fan J., Tian J., Liu L., Gan C., Chen W. and Yin Z.J.: Aesthetic Sideburn Reconstruction with an Expanded Reversed Temporoparieto-occipital Scalp Flap. Craniofac. Surg. Jul., 25 (4): 1168, 2014. 2- Giraldo F., Gonzalez C., Garnica I., Ferron M. and Rus J.A.: Sideburn Reconstruction with an Expanded Supraauricular Trapezoidal Flap. Plastreconstr Surg. Jul., 100 (1): 257, 1997. 3- Sedwick J.D. and Langdoc C.J.: Postauricular Transposition Flap for Cutaneous Auricular Defects. Arch. Facial Plast. Surg., 7 (6): 418, 2005. 4- Davis W.H.: Sideburn Reconstruction with an Arterial VY Hair-bearing Scalp Flap after the Excision of Basal Cell Carcinoma. Plast. Reconstr. Surg. Jul., 106 (1): 94, 2000. 5- Zhang Y.Z., Li Y.L., Yang C., Fang S., Fan H. and Xing X.: Reconstruction of the Postauricular Defects Using Retroauricular Artery Perforator-Based Island Flaps. Anatomical Study and Clinical Report. Medicine, 95: 37: 1, 2016. 6- Youn S., Kim Y.H., Kim J.T., et al.: Successful Reconstruction of a Large Helical Rim Defect Using RetroauEgypt, J. Plast. Reconstr. Surg., January 2018 13 ricular Artery Perforator-Based Island Flap. J. Craniofac. Surg., 22: 635, 2011. 7- Cordova A., D’Arpa S., Pirrello R., et al.: Retroauricular- Skin: A Flaps Bank for Ear Reconstruction. J. Plast. Reconstr. Aesthet. Surg., 61(Suppl 1): S44, 2008. 8- de Almeida O.M. and Gemperli R.: Reconstruction of a Postauricular Defect Using a Preauricular Flap. Dermatol. Surg. Jul., 36 (7): 1191, 2010. 9- Thomaidis V.K.: Cutaneous Flaps in Head and Neck Reconstruction: From Anatomy to Surgery. Online Book. Published by Spriger-Verlag Gambh. Berlin, (6): 84, April 2014. 10- Stark R.B. and Kaplan J.: Rotation Flaps Neck to Cheek. Plast. Reconstr. Surg., 50: 230, 1972. 11- Crow M.L. and Crow J.: Resurfacing Large Cheek Defects with Rotation Flaps From the Neck. Plast. Reconstr. Surg., 58: 196, 1976. 12- Moore B.A., Wine T. and Netterville J.L.: Cervicofacial and Cervicothoracic Rotation Flaps in Head and Neck Reconstruction. Head Neck, 27: 1092, 2005. 13- Kaplan I. and Goldwyn R.M.: The Versatility of the Laterally Based Cervicofacial Flap. Plast. Reconstr. Surg., 61: 390, 1978. 14- Juri J. and Juri C.: Advancement and Rotation of Large Cervicofacial Flaps for Cheek Reconstruction. Plast. Reconstr. Surg., 64: 692, 1979. 15- Becker D.W. Jr.: A Cervicopectoral Rotation Flap for Cheek Coverage. Plast. Reconstr. Surg., 61: 868, 1978. 16- Bokhari W.A. and Wang S.J.: Modified Approach to the Cervicofacial Rotation Flap in Head and Neck Reconstruction. The Open Otorhinolaryngol. J., 5: 18, 2011. 17- Rosenthal E.L., King T., McGrew B.M., Carroll W., Magnuson J.S. and Wax M.K.: Evolution of a Paradigm for Free Tissue Transfer Reconstruction of Lateral Temporal Bone Defects. Head & Neck, 5: 589, 2008. 18- Gurlek A., Alaybeyoglu N., Demir C.Y., Aydogan H., Bilen B.T. and Aezturk A.: Aesthetic Reconstruction of Large Scalp Defects by Sequential Tissue Expansion Without Interval. Aesth. Plast. Surg., 28: 245, 2004. 19- Guzey S., Alhan D., Sahin I., Aykan A., Eski M. and Nisanci M.: Our Experience on the Reconstruction of Lateral Scalp Burn Alopecia with Tissue Expander. Burns J., 41: 631, 2014. 20- LoGiudice J. and Gosain A.K.: Clinical Overview: Pediatric Tissue Expansion: Indications and Complications. Jr. Craniofacial Surg., 14: 866, 2003. 21- Elshahat A.: The Versatility of the Hatchet Flap in Soft Tissue Reconstruction and a Proposed New Classification. Eur. J. Plast. Surg., 35: 351, 2012. 22- Jackson I.T.: Forehead Reconstruction. In: Jackson I.T. (ed) Local flaps in Head and Neck Reconstruction, 2nd edn. Quality Medical, St. Louis, pp 47-100, 2007. 23- Josvay J., Sashegyi M., Kelemen P. and Donath A.: Modified Tensor Fascia Lata Musculofasciocutaneous Flap for the Coverage of Trochanteric Pressure Sores. J. Plast. Reconstr. Aesthet. Surg., 59: 137, 2006. 24- Hayashi A., Maruyama Y., Saze M. and Okada E.: The lateral Thigh V–Y Flap for Repair of Ischial Defects. Br. J. Plast. Surg., 51: 113, 1998. 25- Gillies H.D. and Millard D.R.: The Principles and Art of Plastic Surgery. 2 vols. Little, Brown & Co, Boston, 1957. 26- Emmett A.J.: The Closure of Defects by Using Adjacent Triangular Flaps With Subcutaneous Pedicles. Plast. Reconstr. Surg., 59: 45, 1977. 27- Reynaud J.P.: Hatchet Flap for the Repair of Cutaneous Excisions on the Nose. Ann. Chir. Plast. Esthet., 28: 369, 1983. 28- Horwath H., Roscic I., Falkensammer G. and Engleder R.: Hatchet-Form Flap as a Method of Aesthetic Reconstruction of the Nose. Fortchr Kiefer Gesichtschir, 34: 151, 1989. 29- Baron J.L., Reynaud J.P., Gary-Bobo A. and Maya M.: Specificity of Hatchet Flaps in the Laterofacial Region. Ann. Chir. Plast. Esthet., 35: 47, 1990. 30- Tremblay J.F. and Bernestein S.C.: Hatchet Flap. Dermatol. Surg., 27: 1049, 2001. 31- Pan Y., Ai Y., Li H. and Guo S.: Local Hatchet Flap for Facial Skin Defects Reconstruction in Special Areas. Dermatol. Surg., 30: 1256, 2004. 32- Gargano F. and Alfano C.: Versatility of the Hatchet Flap in Facial Reconstruction. Acta. Chir. Plast., 47: 67, 2005. 33- Yu T.C., Desciak E.B. and Eliezri Y.D.: Bilateral Hatchet Flaps. Dermatol Surg. (32):1279, 2006. 34- Quillot M., Lodde J.P., Pegorier O., Reynaud J.P. and Cormerais A.: A Variant of Island Flaps for the Covering of Pressure Sores: The Hatchet Flap: A Props of 31 Cases. Ann. Chir. Plast. Esthet., 39: 469, 1994. 35- Josvay J. and Donath A.: Modified Hamstring Musculocutaneous Flap for The Coverage of Ischial Pressure Sores. Plast. Reconstr. Surg., 103: 1715, 1999. 36- Demirseren M.E., Gokrem S., Ozdemir O.M., Katircioglu A., Can Z. and Serel S.: Hatchet-Shaped Tensor Fasciae Latae Musculocutaneous Flap for the Coverage of Trochanteric Pressure Sores: A New Modification. Ann. Plast. Surg., 51: 419, 2003. 37- Schwabegger A.H., Delfrari B. and Apprich C.: Pedicled- Deltoid Hatchet Flap for Treatment of Pressure Sore at the Shoulder. Eur. J. Plast. Surg., 28: 534, 2006. 38- Josvay J. and Bognar L.: Large Lumbosacral Meningomyelocele Closure with Gluteus Maximus Musculocutaneous Hatchet Flap. Eur. J. Plast. Surg., 25: 378, 2003. 39- Tuncali D., Barutcu A.Y., Gokrem S., Terzioglu A. and Aslan G.: The Hatchet Flap for Reconstruction of Fingertip Amputations. Plast. Reconstr. Surg., 117: 1933, 2006. 40- Hayashi T., Yamamoto Y., Oyama A., Funayama E., Shichinohe R., Murao N. and Furukawa H.: Reconstruction of Large Cheek Defect With/Without Sideburn Using Malar-Posterior Auricular-Cervico Flap. Ann. of Plast. Surg., 77 (2): 137, 2016 | ||||
Statistics Article View: 158 PDF Download: 641 |
||||