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. 2018 Dec 5;6(12):e2049.
doi: 10.1097/GOX.0000000000002049. eCollection 2018 Dec.

Expanded Utilization of the Digital Atasoy Flap

Enrique J Viciana  1 , Anne-Sophie Lessard  2
Affiliations

Expanded Utilization of the Digital Atasoy Flap

Enrique J Viciana et al. Plast Reconstr Surg Glob Open. .

Abstract

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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Figures

Fig. 1.
Fig. 1.
A, The shaded portion illustrates the volar portion of the distal phalanx to be excised. B, A lateral depiction is seen of the portion of the distal phalanx to be excised. C, The proximal dissection reveals the FDP tendon. There are no major neurovascular branches here. D, As the flap is placed under tension, the ligamentous fibrous septa are visualized. They can also be felt with the dissecting scissors.
Fig. 2.
Fig. 2.
A, The edges of the flap are spread in a perpendicular direction, exposing the ligamentous fibrous septa by placing them under tension. B, The advancing edge is secured to the distal nail bed with 6-0 Vicryl interrupted sutures. C, The tourniquet has been released and satisfactory hemostasis has been obtained.
See this image and copyright information in PMC

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