Bilateral V–Y Rotation Advancement Flap for Fingertip Amputations

Sungur, Nezïh; Kankaya, Yüksel; Yıldız, Kaya; Dölen, Utku Can; Koçer, Uğur

doi:10.1007/s11552-011-9389-6

Cited by 23 publications

(15 citation statements)

References 49 publications

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“…There are various methods of repairing defect of fingertip, including using the random pattern abdominal flap and retrograde digital artery island flap. 1 3 4 5 The large shortage of these surgical methods is the injury of unilateral artery and the postoperative complications such as atrophy and sensation of chill. In addition, in these surgeries the accompanying veins of digital arteries are susceptible to injury, which will lead to venous back flowing dysfunction of the flaps, hyper pigmentation, and even atrophy or necrosis of flaps.…”

Section: Discussionmentioning

confidence: 99%

“…Fingertip defect, one of the most common injuries in the hand, is treated with various flaps such as random pattern abdominal flap and retrograde digital artery island flap. 1 2 3 4 5 However, swelling in the fingertip, dysfunction of sensation and scarring leads to restriction of flexion and extension. Injury to the hemi-artery of the finger usually occurs during the recovery stage.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

Zhu

Kou³

et al. 2014

IJOO

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Background:Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip.Materials and Methods:Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site.Results:Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.Conclusion:Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

Zhu

Kou³

et al. 2014

IJOO

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“…V-Y advancement flaps described by Atasoy et al 2 are easy to carry out and quite suitable for covering a small transverse defect of fingertip. Kutler 11 designed a double lateral advancement flap based on similar principles for distal defect, as well as Sungur et al 12 However, shape of the V-Y flap is not suitable for the special geometry of lateral oblique amputation, and limitation of advancement hinders the recovery of normal appearance of the fingertip.…”

Section: Discussionmentioning

confidence: 99%

A New Triangular Rotation and Advancement Pulp Flap for Lateral Oblique Fingertip Defect

Zhou

Zhao

Zhang

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: The fingertip is one of the most common sites of traumatic injuries faced by hand surgeons. In cases of lateral oblique amputation, only limited alternatives are available for reconstruction. This study introduced a new method involving rotation and use of an advancement pulp flap for covering lateral oblique defect and evaluated its outcome. Method: A series of 12 patients with 14 lateral oblique fingertip defects were recruited in this study. All fingertips were unreplantable and were injured distal to the proximal one-third of nail bed, with phalanx exposed. All cases received surgical reconstruction using a triangular rotation and advancement pulp flap. Static 2-point discrimination, cold intolerance, pain, hypersensitivity, range of motion, and aesthetic satisfaction were evaluated 6 months to 12 months postoperation. Result: Bone defect was noted in 7 cases. The area of defect was 10×7–20×12 mm2, and the angle of defect was 30–60 degrees. Mean follow-up was 14.3 months. No hook nail deformity, cold intolerance, and hypersensitivity were observed. One patient complained about pain postoperation, demanding a second operation. Static 2-point discrimination was between 5 and 8 mm in all cases. Range of motion of distal interphalangeal joint recovered to 20–45 degrees at the last follow-up. No stiffness was observed in the interphalangeal or metacarpophalangeal joints. All patients were satisfied with the appearance of the flap. Conclusion: The triangular rotation and advancement pulp flap is simple, safe, and reliable for treating lateral oblique defect of fingertip, providing scope for anatomical reconstruction and fair sensation and aesthetic recovery.

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“…4,6,[26][27][28] In this technique, skin incisions are shorter than the classical V-Y advancement flap. In addition, while the advancement of the flap increases rotation by decreasing the tension at the pivot point of the classical rotation flap, rotation of the flap also helps to achieve tension-free closure by increasing the advancement.…”

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confidence: 99%

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap

Kankaya

Sungur

Aslan

et al. 2015

PED

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OBJECT Skin grafts, skin flaps, fasciocutaneous flaps, muscle flaps, and musculocutaneous flaps have been used for closure of large meningomyelocele (MMC) defects that cannot be closed primarily. The V-Y rotation advancement flap technique has been used successfully for the reconstruction of defects in different areas of the body. In the present study, the authors report on their novel use of this technique in both a binary and a quadruple (butterfly) flap manner for closure of large MMC defects. They also present an algorithm that they developed for the evaluation of MMC defects. METHODS Between January 2011 and November 2013, 17 patients (13 girls and 4 boys) with extremely large MMC defects that could not be repaired by direct primary closure underwent reconstruction of the defects with binary and quadruple V-Y rotation and advancement flaps. With the patient prone, the axillary apices, the most craniad point of the intergluteal sulcus, and the posterior axillary lines were marked, and a rectangular area on the back was designed. Edges of the rectangular area and the transverse and longitudinal diameters of the defect were measured and the presence of kyphosis was noted. These measurements and their proportions were used to develop an algorithm for patient assessment. While binary flaps were planned over the transverse diameter of the defects, quadruple flaps were planned over the bisectors of the defects, which were closed by elevating fasciocutaneous flaps. RESULTS For patients whose defect diameter to back width ratio was between 0.30 and 0.50 and whose mean ratio of defect area to donor area was between 0.09 and 0.15, binary V-Y rotation and advancement flaps were used. When these values were in the range of 0.50–0.66 and 0.16–0.35, respectively, quadruple V-Y rotation and advancement flaps were preferred. The mean duration of postoperative follow-up was 10.4 months. With the exception of minor complications, such as partial necrosis of 0.5 × 0.5 cm in a quadruple flap, all the flaps healed uneventfully. CONCLUSIONS With this study, closure of MMC defects with V-Y rotation and advancement flaps has been defined for the first time in the literature. The use of this technique with multiple flaps is an effective alternative to other flap options for the closure of large MMC defects. The algorithm developed in the course of this study should facilitate evaluation and reconstruction planning for patients with MMC defects.

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Bilateral V–Y Rotation Advancement Flap for Fingertip Amputations

Cited by 23 publications

References 49 publications

Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

A New Triangular Rotation and Advancement Pulp Flap for Lateral Oblique Fingertip Defect

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap

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