V-Y flap

V-Y Flap

Flap	Volar V-Y (Tranquilli-Leali, Atasoy); lateral V-Y (Geissendörfer, Kutler)
Tissue	Skin
Course of the vessels	In the subcutaneous tissue of the pulp
Dimensions	1 × 1.5 cm
Extensions and combinations	—
Anatomy
Neurovascular pedicle	No defined pedicle
Artery	—
Veins	—
Length and arc of rotation	—
Diameter	5–10 mm
Nerve	—
Surgical technique
Preoperative examination and markings	Slightly laterally curved triangular incision
Patient position	Arm on arm table, digital block or plexus anesthesia, tourniquet
Dissection	Volar flap: incise the skin without violating the subcutaneous tissue; release the fibrous septa from the pulp to the periosteum; trim the bone; pull the flap distally with a Gillies hook; divide the remaining septa; fixate the flap in the defect with a needle; no distal suture needed Lateral flap: cover the defect with bilateral triangular flaps; the limbs of the incision should meet at the distal flexor crease; incise the skin without violating the subcutaneous tissue; release the fibrous septa from the periosteum; trim the bone; pull the flap medially with a Gillies hook; release the remaining septa; fixate the flap to the contralateral flap with sutures or use two needles
Advantages
Dissection	Simple and reliable
Flap size and shape	Small defects of the fingertip can be covered with sensate skin
Donor site	Primary closure with V-Y technique or loose approximation of the skin
Disadvantages
Flap size	Sometimes too small
Pearls and pitfalls
Dissection	Do not injure the subcutaneous tissue; do not suture the flap distally, because this will impair the blood supply; the flap is frequently pale after release of the tourniquet, wait and then rinse with warm saline
Extensions and combinations	—
Contouring and correction	Very rarely required
Clinical applications	Small defects of the fingertips