Principles of hatchet-skin flap for repair of tissue defects on the cheek

To date, cheek reconstruction remains a challenge for plastic surgeons. This report presents the authors' cheek reconstruction technique with different types of hatchet-skin flaps, which provides satisfactory results.

The cheek area was divided into three parts (P1, P2, and P3), with vertical lines passing through the medial and lateral canthus. Different types of hatchet-skin flaps were used to repair the tissue defects in each part. The study population consisted of 29 patients divided into three groups according to the location of the defect (G1, G2, and G3). Patient satisfaction was evaluated 1 year after the operation using a questionnaire concerning five important aspects: color match, texture match, scar visibility, morbidity, and function.

The 29 patients (17 men and 12 women) ranged in age from 19 to 81 years. The sizes of the defects ranged from 1.5×1.5 to 2.5×3.5 cm. All the flaps survived. The patients' ages and defect sizes did not differ between the three groups. The mean rating of each evaluation was high in all three groups. The mean rating for scar visibility on a 5-point scale was significantly lower for G1 than for G3.

The hatchet-skin flap procedure is a versatile technique for the repair of medium defects in the three parts of the cheek. The defects in each part of the cheek should be repaired separately depending on the characteristics of the natural lines.