1. Intraoperative local flap transforming (iLoFT) method; from hachet to reading-man flap 
Motoi Kato, Shinnosuke Kimura, Masayuki Okochi, Kazuki Ueda, Shoji Watanabe, Azusa Watanabe, Tatsuki Kono 
JPRAS Open 
Volume 12, Pages (June 2017)
DOI: /j.jpra
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2. Figure 1 Preoperative design of a reading man flap on the hip.
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3. Figure 2
Reading man flap at 3 months following surgery. No recurrence or complications occurred.
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4. Figure 3
A patient with dermatofibrosarcoma protuberance with a round resection and 4-cm horizontal margin from the skin lesion. A hachet flap was elevated to cover the defect.
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5. Figure 4
As tension on the donor site was too strong to close the primary with a hatchet flap, it was transformed to a reading man flap.
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6. Figure 5
Six months postoperatively in which the iLoFT method was applied to change a hatchet flap to a reading man flap.
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7. Figure 6
Preoperative design to reconstruct a lumbar soft tissue defect followed by resection.
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8. Figure 7
Intraoperatively, the donor site was found to be too strong for closure of the primary, so the iLoFT method was considered.
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9. Figure 8
Ten months postoperatively without recurrence, complications or scar hypertrophy.
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10. Figure 9
Preoperative nevus on the forehead. A hatchet flap was initially planned.
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11. Figure 10
A hatchet flap was intraoperatively elevated. As the donor site and the flap tension were not too strong for defect coverage, iLoFT was not applied.
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12. Figure 11 Three months postoperatively.
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13. Figure 12
The concept of the iLoFT method transformation from a hatchet flap to a reading man flap. The tension is visualized by the finite element method. The long red line indicates strong tension compared with the shorter green short line that indicates weaker tension.
JPRAS Open  , 66-75DOI: ( /j.jpra )
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14. Figure 13
Possible design rotation of a reading man flap because of donor site tension related to preoperative design. Horizontal Green line as Relaxed skin tension lines (RSTL). Vertical Blue line as perpendicular line of the RSTL. (Left: Original Design, Right: Rotated Design)
JPRAS Open  , 66-75DOI: ( /j.jpra )
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15. Figure 14
Various possible iLoFT transformations from the hatchet flap.
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