15 Local and Regional Hand Flaps
15.1 Atasoy V-Y flap
The length of the digit should be preserved and in many cases one can avoid terminalization of the digit. The V-Y flap described by Atasoy is appropriate for dorsal oblique and transverse amputations of the fingertip. To avoid a minimal advancement, it is important to release fibrous septa and detach the flap from the underlying flexor sheath. Through the following illustrations, it is described how to avoid the V-V flap (Fig. 15‑1, Fig. 15‑2, Fig. 15‑3, Fig. 15‑4, Fig. 15‑5, Fig. 15‑6, Fig. 15‑7).
15.2 Cross Finger Flap
This robust flap is useful in patients who are smokers and have significant comorbidities that could compromise the blood supply of islanded flaps. It is useful for large volar oblique defects of the fingertip and can be divided at 2 weeks. The shortcoming is the poor donor site and ensuing stiffness that can particularly result in adult patients (Fig. 15‑8, Fig. 15‑9, Fig. 15‑10).
15.3 Venkataswami Flap
This flap is suited to volar oblique defects and involves islanding the flap on its neurovascular pedicle (Fig. 15‑11, Fig. 15‑12, Fig. 15‑13, Fig. 15‑14, Fig. 15‑15, Fig. 15‑16). It is often necessary to divide branches from the artery that supply the flexor tendon. For larger defects, more advancement is needed and one must perform the dissection down to the base of the digit.
The Evans flap is a variation which involves creating steps instead of a straight line. This theoretically reduces the chances of scar contracture although it is harder to design.
15.4 Moberg Flap
Thumb length should be preserved at all costs. To preserve length in volar oblique defects of the thumb tip, a Moberg flap can be performed. This volar advancement flap is raised using two mid-axial incisions and is based on both neurovascular bundles of the thumb, which run closer to the midline than compared to the digits.
In the original description of this flap, the thumb was simply flexed at the interphalangeal joint (IPJ) to gain flap coverage; however, subsequent modifications have involved islanding the flap to gain greater advancement. These include a V-Y plasty over thenar crease (Fig. 15‑17, Fig. 15‑18, Fig. 15‑19), or a transverse proximal incision, which is then skin grafted.