Long-Term Comparison of Esthetic Outcomes Between Hatchet and Transposition Flaps in Facial-Defect Reconstruction

Taegyu Lee; Junhyung Kim; Woonhyeok Jeong; Taehee Jo; Jaehoon Choi; Sang Woo Park

doi:10.1007/s00266-024-04053-7

Long-Term Comparison of Esthetic Outcomes Between Hatchet and Transposition Flaps in Facial-Defect Reconstruction

Aesthetic Plast Surg. 2024 Apr 30. doi: 10.1007/s00266-024-04053-7. Online ahead of print.

Authors

Taegyu Lee¹, Junhyung Kim¹, Woonhyeok Jeong¹, Taehee Jo¹, Jaehoon Choi^#², Sang Woo Park^#³

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, 56 Dalseong-ro Jung-gu, Daegu, 41931, Republic of Korea.
² Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, 56 Dalseong-ro Jung-gu, Daegu, 41931, Republic of Korea. psjchoi@dsmc.or.kr.
³ Department of Plastic and Reconstructive Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.

^# Contributed equally.

PMID: 38691174
DOI: 10.1007/s00266-024-04053-7

Abstract

Background: Transposition flaps are commonly used for facial-defect repair after wide excision of skin cancers. However, such repair often causes excessive tension at the donor site that can result in distortion of the adjacent area. The hatchet flap, a rotation-advancement flap, can prevent distortion by redistributing the donor site tension evenly to the recipient site. This study aims to compare the esthetic outcomes of the hatchet flap and transposition flap in facial-defect reconstruction.

Methods: We retrospectively included 50 patients who underwent facial reconstruction with the hatchet flap or transposition flap after excision of skin cancer. They were followed up for more than 6 months. At the last follow-up visit, the esthetic outcome was evaluated by subjective and objective assessments using the patients and observer scar assessment scale and Manchester scar scale.

Results: Thirty patients and 20 patients underwent reconstruction using the hatchet flap and the transposition flap, respectively. The total score from the patient and observer scar assessment scale was significantly lower in the hatchet flap group compared with the transposition flap group (p = 0.009). The Manchester scar scale showed a total score of 7.67 ± 2.2 for the hatchet flap and 9.95 ± 1.99 for the transposition flap: in the color (p < 0.001), distortion (p < 0.001), and texture (p < 0.02) categories, the hatchet flap yielded significantly better outcomes than the transposition flap.

Conclusions: The hatchet flap had good esthetic outcome for facial reconstruction and could be a valuable option for reconstructing facial defects.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Keywords: Hatchet flap; Skin cancer; Transposition flap.

Abstract

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