The “Forklift” Flap: A Conjoined Perforator Flap for Bilateral Cervicofacial Reconstruction

Background: Cervicofacial defects have a profound functional, aesthetic, and psychological impact. If optimal bedside wound care fails, surgical management is warranted. We propose our innovative forklift flap technique in the reconstruction of medically-refractory Hurley Stage III hidradenitis suppurativa (HS) affecting the lower face, submentum, and neck: providing both improved functionality and aesthetic appearance. Methods: Full-thickness excision of the area was performed with immediate reconstruction utilizing our novel forklift flap—a local, doublysupercharged, independent branch-based, conjoined perforator flap. The flap encompasses the vascular territories of the supraclavicular, parascapular and lateral arm flaps. The flap remained pedicled on the supraclavicular artery and supercharged with both the circumflex scapular and the posterior radial collateral arteries. The supraclavicular, parascapular, and extended lateral arm measured 33 cm × 8 cm, 30 cm × 10 cm, and 53 cm × 14 cm, respectively, and resulted in 1306 cm 2 of coverage. The supraclavicular and parascapular sites were closed primarily with interspersed penrose drains. The lateral arm healed by secondary intention following application of a dermal regeneration template. Five months postoperatively, 2000 mL debulking was performed with liposuction. Results: Results were stable at subsequent postoperative visits. At 2 years follow up, minor recurrence of submental HS occurred adjacent to our flap. Conclusion: Surgical management is an optimal choice for patients with refractory HS lesions. Our forklift flap technique provides satisfactory aesthetic and functional outcomes for large cervicofacial defects.