Chapter 31 Table 31.1 V-Y flap for fingertips
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 |
