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Background <p>The face, with its distinct subunits, demands particularly high aesthetic standards for defect reconstruction. Although traditional hatchet flaps are commonly used, they are limited by a constrained rotation arc and susceptibility to dog-ear deformities, compromising aesthetic outcomes. This study introduces and investigates a novel free-style perforator-based hatchet flap technique designed to overcome these limitations and enhance aesthetic outcomes.</p> Patients and methods <p>Patients treated at a single center between October 2020 and April 2024 were included. The key innovation involves preoperative Doppler ultrasound mapping of perforating vessels combined with a “free-style” design principle, liberating the flap from constrained rotation and reducing the risk of dog-ear deformities associated with traditional hatchet methods. This approach enables an increased rotational arc. Outcomes were evaluated at follow-up using the Visual Analog Scale (VAS), Observer Scar Assessment Scale (OSAS), and Patient Scar Assessment Scale (PSAS).</p> Results <p>This retrospective analysis included 65 patients (32 free-style, 33 traditional). All free-style flaps survived, whereas partial necrosis occurred in three traditional flaps. The free-style group showed improved aesthetic outcomes, including higher VAS scores, lower OSAS scores, shorter mean scar length, and lower PSAS scores, indicating greater patient satisfaction with scar appearance.</p> Conclusion <p>The free-style perforator-based hatchet flap, facilitated by preoperative perforator mapping, was associated with better aesthetic outcomes and higher patient satisfaction compared to the traditional technique in this retrospective cohort.</p>

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Free-style perforator-based hatchet flap: a novel and innovative approach for superior aesthetic outcomes in facial defect reconstruction

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月17日

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  • YiChun Ding,
  • TingTing Wang,
  • Lin Zhang,
  • Hao Ding,
  • XinYi Li,
  • XiaoJing Li

摘要

Background

The face, with its distinct subunits, demands particularly high aesthetic standards for defect reconstruction. Although traditional hatchet flaps are commonly used, they are limited by a constrained rotation arc and susceptibility to dog-ear deformities, compromising aesthetic outcomes. This study introduces and investigates a novel free-style perforator-based hatchet flap technique designed to overcome these limitations and enhance aesthetic outcomes.

Patients and methods

Patients treated at a single center between October 2020 and April 2024 were included. The key innovation involves preoperative Doppler ultrasound mapping of perforating vessels combined with a “free-style” design principle, liberating the flap from constrained rotation and reducing the risk of dog-ear deformities associated with traditional hatchet methods. This approach enables an increased rotational arc. Outcomes were evaluated at follow-up using the Visual Analog Scale (VAS), Observer Scar Assessment Scale (OSAS), and Patient Scar Assessment Scale (PSAS).

Results

This retrospective analysis included 65 patients (32 free-style, 33 traditional). All free-style flaps survived, whereas partial necrosis occurred in three traditional flaps. The free-style group showed improved aesthetic outcomes, including higher VAS scores, lower OSAS scores, shorter mean scar length, and lower PSAS scores, indicating greater patient satisfaction with scar appearance.

Conclusion

The free-style perforator-based hatchet flap, facilitated by preoperative perforator mapping, was associated with better aesthetic outcomes and higher patient satisfaction compared to the traditional technique in this retrospective cohort.