The Hatchet Flap for Reconstruction of Fingertip Amputations

Abstract

Background: Emmett has 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 defects located on various body parts. The aim of this study was to present the authors' experience and results obtained with this flap in fingertip amputations. Methods: Nine patients who have completed their 1-year follow-up period were included in the study. Two-point discrimination and stiffness were tested, and the patients were queried about the existence of cold intolerance, hypersensitivity, numbness, and pain in the early (3 months) and late (1 year) postoperative periods. Results: The amputations were located on the thumb in three patients, index finger in one patient, middle finger in three patients, and ring finger in two patients. The average defect size was 2.1 ϫ 1.5 cm. Partial wound dehiscence was observed in one patient. The flap has provided good protective padding and aesthetic contour for the fingers. All incisions healed with inconspicuous scars. Average two-point discrimination was 6.3 mm (range, 4 to 8 mm). Cold intolerance was observed in two (22.2 percent) and paresthesia in one patient (11.1 percent). Joint stiffness was not noted. Most patients could return to their normal routine in approximately 4 to 5 weeks. Conclusions:The hatchet flap is a good alternative for transverse and lateral oblique fingertip amputations and valuable for volar oblique amputations (defects Ͻ2 cm) with more extensive flap designs. The technique is simple and safe and provides good protective padding and acceptable tactile gnosis. (Plast.

Bilateral V–Y Rotation Advancement Flap for Fingertip Amputations

“…It differs from the hatchet flap of Tuncali et al from being bilateral and depending on two different pedicles for smaller flaps than one pedicle for larger flaps [39]. We have not seen any perfusion problem because the digital artery and its branches are more than enough for such a small flap.…”

“…However, there is a consensus that replantation is the best choice by maintaining the length of the finger and the normal anatomy of the nail complex, if only the amputated fragment is available, in replantable condition and well preserved [34,42]. If replantation is not possible, reconstruction ladder could be used for fingertip injuries: secondary healing, primary closure, skin grafting, homodigital flaps (V-Y advancement [4], V-Y cup [41], dorsal visor [20], Kutler [25], Moberg [35], hatchet [4], Hueston [10], linguiform rotation [12], dorsal adipofascial flaps [26,28,40], cross-finger flap [20,25], island flaps (homodigital [5,7,13,29,38], heterodigital [30] and metacarpal [19]) (antegrade and retrograde [38]), digital artery perforator flaps [23], distant flaps (thenar flap [10], groin and abdominal), free flap (free toe pulp [9,22,31], venous [33,39] and medial plantar perforator [17,42]). …”

“…Flaps are classified mainly into homodigital flaps [4,10,12,17,20,25,33,39,42], heterodigital flaps (cross-finger flap [7,29]), distant flaps [10], island flaps (homodigital [1,5,13,38,44], heterodigital [30] and metacarpal [19]), perforator flaps [23] and free flaps [9,21,24,27,45].…”

Soft Tissue Cover of the Hand

“…It has also been described for resurfacing small defects of the fi ngertip pulp [ 17 ]. In essence it is designed as a volar VY fl ap with three quarters of one side of the V left intact, on which the fl ap rotates and advances ( Fig.…”

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].…”