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Background:The Atasoy, or Kleinert flap, is well-known to hand surgeons. This triangular volar V-Y flap is frequently used for reconstruction of fingertip amputations with exposed bone. It is indicated in transverse amputations or in dorsal oblique amputations, providing replacement of an area of skin and subcutaneous tissues with sensibility. Originally, this flap was not recommended for use in volar oblique amputations (greater volar tissue loss). With the described modifications and recommendations, modest volar oblique amputations can be closed in a single stage, obviating a 2-stage procedure.Methods:With the described technical modifications, modest volar oblique amputations can be closed. An injury that previously may have required a 2-stage procedure can be closed in a single stage.Results:The elevation of the flap was originally described as a dissection at the volar periosteum from a distal approach. This distal dissection is no longer recommended, as it does not create advancement. Beasley indicated the need for division of the vertical fibrous septa proximally for flap mobilization. This technique description emphasizes the importance of this division of the fibrous septa rather than stretching. Careful treatment of the remaining bone is stressed. Coverage of the nail bed is not recommended.

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Summary: Transposition flaps are useful for reconstruction of many skin defects. Limberg described a rhomboid rotation flap in 1946. Dufourmentel described an improved version of the Limberg flap in 1962. The Dufourmentel flap is also a quadrangular rhomboid flap which can be used in any area of the body except for the central face, the fingers, and the volar hand. The design of the Dufourmentel flap creates a wider base for this random flap, thus making it more reliable. Where tissue loss is significant, or where skin and soft tissue elasticity is limited, double opposing Dufourmentel flaps are useful. A variation of the Dufourmentel flap is described where a circular defect is converted to a square. The line of greatest extensibility is marked through the circular defect or lesion. A square is marked around the circle with one corner of the square tilted 10–20 degrees counterclockwise from the line of greatest extensibility. After marking corners A, B, C, and D, lines are marked extending BD and CD. The first incision, DE, will bisect the angle created by extending BD and CD. The second incision, EF, is roughly perpendicular to CD extended, but the angle at E is opened up a bit to create a wider base for the flap. Point D will rotate to point B, E rotates to C, and F translates to D. The invisible line DF should be approximately parallel to the line of greatest extensibility. When the defect is relatively large or where the surrounding tissues have limited elasticity, the above-described ideal variation of the Dufourmentel flap may not be possible because the flap may not rotate and advance all the way around without tension. In this case, double opposing Dufourmentel type flaps have been found to be useful by meeting each other at the halfway point.