Bilateral V-Y rotation advancement flap for fingertip amputations

Abstract

Background: Fingertip amputation is the most common type of injury in the upper limb. Goals in fingertip amputation reconstruction are covering the defect, establishing maximum tactile gnosis, keeping the length of the finger, protecting the joint function, acquiring a well-padded pulp tissue, providing a bed for growing nail, obtaining a satisfactory cosmetic appearance and allowing the patient to return to work as soon as possible. Adjacent skin and soft tissue are the best covers for fingertip injuries. However, local homodigital flaps lack enough tissue to cover the defect. To solve this problem, we used V-Y rotation advancement flap bilaterally in fingertip amputations which meets all the reconstruction goals. Rotation besides advancement makes this flap more mobile and easier to cover larger defects in all amputation planes.

Methods: Between 2007 and 2009, we performed bilateral V-Y rotation advancement flap on seven male patients' pulpa (average age, 37.6 years) whose fingertips were not replantable.

Results: Fourteen flaps were made on 7 fingers. There was neither total nor partial flap loss. Patients had neither cold intolerance nor scar hypersensitivity. Stiffness of the PIP joint did not occur. No obvious hooked nail occurred in patients who have remaining nail matrix. Because flaps contain neurovascular bundle, there was no difference in sensation and perfusion between the finger's pre-operative and post-operative status. The result was satisfactory with painless pinching.

Conclusion: In addition to the various and versatile fingertip reconstruction methods, we want to present V-Y rotation advancement flap as a quick, reliable and aesthetic method.

Keywords: Amputation; Fingertip; Pulpa; Reconstruction; V–Y flap.

Fig. 1

Index finger, dorsal oblique amputation at Ishikawa zone III (patient 5)

Fig. 2

Pre-operative drawing of V–Y rotation advancement flap for dorsal obliquely amputated fingertip (patient 5)

Fig. 3

Demonstration of digital artery inside the flap (patient 3)

Fig. 4

Incision of the flap (patient 5)

Fig. 5

Rotation and the advancement of movements of the flap (patient 5)

Fig. 6

Illustration of the fingertip reconstruction with V–Y rotation advancement flap. Left Ishikawa zone III, transverse fingertip amputation and design of “V”-shaped flaps. Centre transfer of flaps by keeping neurovascular bundle inside. Right “Y”-shaped closure of the defect

Fig. 7

a Dorsal view of patient 3 with transverse, Ishikawa zone III index fingertip amputation. b Volar view of the finger. c Design of flaps which extend to the lateral sides of the finger. d Transfer of flaps. e Dorsal view of the closure. f Volar view of the closure. g Dorsal view, first post-operative month. h Volar view, first post-operative month. i Volar view, sixth post-operative month

Fig. 8

a Flaps design of patient 2 who has Ishikawa zone II, transverse thumb tip amputation. b Volar view of the closure. c Lateral view of the thumb, first post-operative month. d Close-up view of pulpa with minimal incision scar