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Reconstructive Outcomes Analysis of Lower Eyelid and Infraorbital Skin Defects Using 2 Hatchet Flaps: A 6-Year Experience

Gurunluoglu, Raffi MD, PhD, FACS*; Williams, Susan Annette PA-C*; Olsen, Adam DMD, MBA

doi: 10.1097/SAP.0b013e31826a1abb
Head and Neck Surgery

Background For the past 6 years, we have used double hatchet flaps for reconstruction of lower lid and infraorbital skin defects.

Methods Twenty-five patients who underwent reconstruction of lower eyelid/infraorbital skin defects using double hatchet flaps were retrospectively analyzed. Defect size ranged from 11 × 11 to 15 × 15 mm. In addition, pearls and pitfalls of the technique are discussed along with the presentation of 3 cases.

Results Flaps were highly viable in all patients. There was no eyelid retraction, scleral show, ectropion, or entropion. Mean follow-up period was 13.7 months. Patient satisfaction with respect to scar appearance was assessed by the standard 5-point scale. Overall patient satisfaction score was 4 (satisfied) in 6 patients, and was 5 (very satisfied) in 19 patients.

Conclusions On the basis of the critical review of outcomes in 25 patients, use of double hatchet flaps for the repair of lower lid and infraorbital skin defects gives an excellent functional and aesthetic result. Horizontal movement of the hatchet flaps avoids vertical skin tension in the lower eyelid, and hence minimizes potential complications.

From the Departments of *Plastic and Reconstructive Surgery and †Oral and Maxillofacial Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, CO.

Received March 6, 2012, and accepted for publication, after revision, July 16, 2012.

Conflicts of interest and sources of funding: none declared.

Raffi Gurunluoglu was responsible for the performance of reconstructions, the conception and design of the article, analysis and interpretation of data, drafting of the article, and final approval of the version to be submitted. Susan A. Williams was responsible for the analysis and interpretation of data, and drafting of the article. Adam Olsen provided assistance in the operating room for cases, acquisition of data, and drafting the article.

Reprints: Raffi Gurunluoglu, MD, PhD, FACS, Department of Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 777 Bannock St, Denver, CO 80204. E-mail:

© 2014 by Lippincott Williams & Wilkins