V-Y flap

Chapter 31


V-Y Flap


Table 31.1 V-Y flap for fingertips
























































































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


May 9, 2019 | Posted by in Reconstructive surgery | Comments Off on V-Y flap

Full access? Get Clinical Tree

Get Clinical Tree app for offline access