Hatchet-Shaped Tensor Fascia Lata Musculocutaneous Flap for the Coverage of Trochanteric Pressure Sores: A New Modification

Abstract

The tensor fascia lata flap is one of the appropriate choices for the coverage of trochanteric pressure sores. The authors designed a new, hatched-shaped tensor fascia lata musculocutaneous flap with distal Z-plasty closure and applied it to four trochanteric defects in 4 patients. Satisfactory results were obtained in all patients. The hatchet-shaped tensor fascia lata musculocutaneous flap is very safe, reliable, and practical. Designing the flap in a hatchet shape allows one to use the proximal and well-vascularized portion of the flap in the trochanteric pressure sore area. Another important advantage is the possibility of reuse resulting from recurrence. Prevention of a "dog-ear" deformity at the recipient site provides a smooth contour on the lateral aspect of the thigh. Another advantage is the tension-free Z-plasty closure of the donor site without need of grafting.

The Hatchet Flap for Reconstruction of Fingertip Amputations

“…17,19,20 The most important benefit of the hatchet flap is that a rotational movement is ingrained in its original design along with a classic advancement. Despite the fact that finger skin is not as elastic as the skin of other parts of the body, the skin bridge still does not hinder the flexibility of the flap.…”

“…15 In 1977, Emmett 16 described a single triangular flap that contains a partial skin bridge on one of its sides and called it the hatchet flap. It was successfully used for reconstruction of facial defects, 17 ischial 18 and trochanteric 19 pressure sores, and various defects located on other body parts. 20 To the best of our knowledge, application of this versatile flap for fingertip amputations has not been reported previously.…”

Significance of anatomical variations of the lateral circumflex femoral artery for the tensor fasciae latae flapping

“…However, we think that the great trochanter is a significant point in orientation but not precise enough. The ascending branch, which is dominant in the vascularisation of the flap as a unique vessel, or its terminal branches which arise prior to the entrance into the muscle, enter the TFL muscle in various levels of the determined distance (anterior superior iliac spine -the location of muscle fibres transferring into the iliotibial tract), most commonly in the middle [1,6].…”

“…This way of bifurcation and the pathway of the ascending branch are noticed in the cases of inferior separation of the PFA from the FA in the femoral triangle of Scarpa, when the LCFA separated directly from the FA. The understanding of the way of separation, the angle of bifurcation, the pathway, with the way of entrance of the ascending branch into the muscle is of great importance in assessing the vascular stalk during reconstructions or graft application [1,4,6,10,36,37]. Some authors share the opinion that the TFL muscle is vascularised by the descending branch of the LCFA [29], or even by the transverse branch of the LCFA, where 5 to 7 perforator vessels are always present [14], which was not noticed in our sample.…”

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

“…This provided a skin pedicle in addition to the subcutaneous pedicle [1]. Emmett [2] was the first to describe the hatchet flap, and following this flap was described in facial reconstruction [3][4][5][6][7][8][9], pressure sore reconstruction [10][11][12][13][14], lumbosacral meningomyelocele reconstruction [15], and fingertip amputation reconstruction [16].…”