Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries

Abstract

We report the use of obliquely oriented V-Y advancement pulp flaps to reconstruct 17 consecutive, lateral oblique fingertip traumatic defects over a 2-year period. All flaps survived completely with no bone protuberance, prominent scar or neuroma evident at an average follow-up of 11 months (range 7 to 19). Although there was no incidence of severe hook nail deformities, there were two patients who had residual mild hook nails, two with pulp/nail asymmetries and one with an ingrown nail. The mean static two-point discrimination was 3.6 mm (range 3 to 8) and the mean Semmes–Weinstein monofilament test score 3.9 g (range 2.44 to 4.56). No correlation was found between the flap obliquity angle and sensory test results. We recommend the obliquely oriented V-Y pulp flap as a reliable reconstructive option for the cover of lateral oblique fingertip defects. Level of evidence: IV

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve

“…15 Although the technique remains one of the most secure and popular reconstructive options with overall good results, it should not be advanced more than 15 mm distally. 14,16,17 Abdominal flaps can repair large areas of finger defects, as well as multiple or complex defects. The procedure does not damage the main blood vessels, and the survival rate is high.…”

“…V-Y advancement flap is appropriate for a small soft-tissue defect, which can obtain satisfactory wear resistance, appearance, and sensory recovery without causing damage to the donor area 15 . Although the technique remains one of the most secure and popular reconstructive options with overall good results, it should not be advanced more than 15 mm distally 14,16,17 . Abdominal flaps can repair large areas of finger defects, as well as multiple or complex defects.…”

Reporting numerical values for sensory testing

“…As individual filament numbers are based on a logarithmic scale, it is not appropriate to simply divide the sum of the filament numbers obtained from each patient by the number of patients in the series to obtain a mean value, although some have done this ( Arik et al., 2021 ). In this situation, the modal (most frequently occurring) value should be given, along with the range.…”

Reverse digital artery island flap with versus without sensory nerve coaptation for finger pulp reconstruction

“…Local regional flaps, such as V–Y advancement flap, 3,4 cross‐finger flap, 5,6 and thenar flap 7–9 have all been described, which can be easily harvested. Nevertheless, the V–Y advancement flap has limited mobility.…”