Making the V-Y advancement flap safer in fingertip amputations

Thoma, Achilleas; Vartija, Larisa Kristine

doi:10.4172/plastic-surgery.1000665

Cited by 10 publications

(8 citation statements)

References 2 publications

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“…Furthermore, donor-site morbidity should also be minimized. Local transposition flaps, advancement flaps and homodigital neurovascular island flaps are common techniques for the reconstruction of fingertip and pulp injuries with satisfactory sensory recovery (Atasoy et al, 1970;Baumeister et al, 2002;Lanzetta et al, 1995;Ni et al, 2012;Sano et al, 2008;Silva et al, 2013;Thoma and Vartija, 2010). However, these methods are recommended only for small to moderate dimensional defects (<2 cm in length).…”

Section: Discussionmentioning

confidence: 99%

Modified Littler flap for sensory reconstruction of large thumb pulp defects

Wang

Yang

Chen

et al. 2018

J Hand Surg Eur Vol

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Section: Discussionmentioning

confidence: 99%

Modified Littler flap for sensory reconstruction of large thumb pulp defects

Wang

Yang

Chen

et al. 2018

J Hand Surg Eur Vol

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“…The V-Y advancement flap, often used in transverse or oblique dorsal fingertip amputations, provides satisfactory contour and sensation without the need for postoperative immobilization 11 . The flap should not be stretched while closing to prevent necrosis that may otherwise occur with the flap 12 . In our study, necrosis developed in 2 patients' flaps which required more than 1 cm of advancement.…”

Section: Discussionmentioning

confidence: 99%

Fingertip Amputations Repair with V-Y Flap and Polyethylene Nail

ÖZDEMİR

ELMA

2022

CMJ

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Background: Finger amputations are the most commonly encountered amputation injury in the upper extremities. It is important to avoid shortening and to preserve the length of the finger in fingertip amputations in order not to lose the functions of the hand. The aim of this study was to evaluate the results of our patients who underwent reconstruction using V-Y pulp flap and artificial nail in order to avoid donor site morbidity in fingertip defects. Methods: The results of patients who underwent reparation with V-Y flap and polyethylene nails for exposed distal phalanx and partial nail bed defect after fingertip amputation were evaluated in this retrospective study. The data of 44 patients who underwent 44 V-Y advancement flap between January 2016 and January 2021 were retrospectively analyzed. Results: A total of 44 patients, 5 female and 39 male, who were treated for fingertip amputation, with a mean follow-up period of 24.2 months (14-71) and a mean age of 34.75 (2-68) were included in the study. The mechanism of injury was guillotine-style, avulsion and crush injuries in 15 (34.1%), 11 (25%) and 18 (40.9%) patients, respectively. Among the patients, 25 (56.8%) had right hand injuries, while 19 (43.2%) had left hand injuries. The dominant hand was affected in 28 (63.6%) patients. In 5 patients, the distal phalanx was shortened to the level of the lost nail bed (shortening was maximum 5 mm). Nail formation had occurred in all patients and deformed nail structure was seen in 18 patients. Graft necrosis was seen in 2 patients. Conclusion: It is difficult for surgeons to decide on the treatment method because of the fact that there are multiple surgical techniques in the literature and the results are reported differently. Success rates are high in our technique. Each techniq.ue has its own advantages and disadvantages.

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“…The V-Y plasty has been used commonly in covering defects of fingertip injuries; despite its being considered a simple procedure, it poses a significant challenge [ 23 – 26 ]. Regardless of its satisfactory outcome and good sensory recovery, closure under tension remains a problem resulting in tissue necrosis and flap failure [ 27 ]. In our case, flap tension was avoided by suturing it to the advanced proximal skin fold flap, which prevented the flap from moving too far.…”

Section: Discussionmentioning

confidence: 99%

Salvaging the Digit in Invasive Subungual Malignancies Using a Triple Technique under Awake Local Anesthesia

Chaar

Alkhatib

et al. 2021

Case Reports in Orthopedics

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Introduction. Amputation for subungual malignancy (SUM) was thought to be the gold standard in preventing recurrence and metastasis. The rationale behind this aggressive treatment was never based on scientific evidence. Even though multiple recent studies supported more conservative management by illustrating successful results of the digit salvage technique, especially for “in situ” SUM, this salvage approach is not well supported for the more aggressive type of the “invasive” SUM; herein, we salvaged two cases of “invasive” SUM. Case Presentation. We present two cases of invasive SUM without radiographic evidence of intraosseous involvement, where we avoided digit amputation for both invasive subungual squamous cell carcinoma of the thumb and invasive subungual melanoma of the ring finger. Both were salvaged by using a triple technique under awake local anesthesia which included (I) radical excision of the nail bed unit including both eponychium and periosteum, (II) dorsal cortical bone shaving using a high-speed burr for the distal phalanx, and (III) flap coverage. Brunelli flap was used for the thumb in the first case, and V-Y plasty combined with proximal nail fold advancement flap was used for the ring finger in the second case. There was no evidence of local or distant recurrence, with a good functional outcome after 2.5 years in the first case and 2 years in the second. Conclusion. Ensuring complete resection with negative margins while preserving the functionality of the affected digit is considered to be the optimal challenge in treating “invasive” subungual malignancies. These two case reports contribute by reporting a successful digit salvage. The safety of this procedure could be confirmed by larger series and longer follow-up periods.

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Making the V-Y advancement flap safer in fingertip amputations

Cited by 10 publications

References 2 publications

Modified Littler flap for sensory reconstruction of large thumb pulp defects

Modified Littler flap for sensory reconstruction of large thumb pulp defects

Fingertip Amputations Repair with V-Y Flap and Polyethylene Nail

Salvaging the Digit in Invasive Subungual Malignancies Using a Triple Technique under Awake Local Anesthesia

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