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Case 4: Double hatchet flap on lower leg, MM resection

Authors: Mari Irgens Bøkset, M.D., Magnus Balslev Avnstorp, M.D.

A 48 year-old male patient was admitted to the dept of Plastic Surgery with a 0,4 mm superficial spreading malignant melanoma on lateral lower left leg. The defect is to be re-excised in 10 mm margin and to the muscle fascia, according to the Danish guidelindes. Afterwards to be reconstructed.

Before and after

Pre-Operative Considerations

Reconstruction could not be performed using primary suturing.

The defect was closed using two opposing rotation flaps, in order to avoid skin grafting.

Two rotation flaps were designed from each side of the defect, with back-cuts in order to allow sufficient mobilization of the flaps into the defect, creating double hatchet flaps.


Step 1: Pre-operative markings

Pre-operative view following primary excision. Design of double hatchet flaps.


Step 2: After closure

Post-operative view following final skin closure.


Step 3: After closure

Post-operative view following final skin closure.