Double hatchet flap as adequate dermatosurgical approach for tumours of the occipital scalp zone: Presentation of two cases

Tumors of the scalp remain a serious challenge for clinicians since poor locoregional skin elasticity hinders the ability to utilise certain flaps, limiting the choice of reconstructive techniques available. As a result, surgical restoration of medium to large-sized defects are left to the discretion of the surgeon, who with a comprehensive knowledge of restorative techniques, along with the advantages, limitations as well as a sound understanding of the locoregional anatomy, can make thorough decisions on the choice of which flap is best suited for the defect. Here we present two cases where the double hatchet flap was employed as a dermatosurgical approach in order to provide exceptional cosmetic results. On dermatological examination, both patients presented with a medium to large- sized tumour formation but were otherwise in good health. Both underwent radical, widelocal excision, followed by reconstructive manipulation in the form of a double hatchet flap to close the defect. Postoperative follow- up reported positive signs of wound healing with aesthetically pleasing results. Finally, we discuss the use of various flaps in such conditions while providing evidence for the double hatchet flap as a possible alternative that provides perfect aesthetic results as seen in our cases. Such a complex surgical intervention requires the expertise of a multidisciplinary team in order to achieve an overall successful outcome.