V-Y Advancement flap - for Fingertip amputations
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VY advancement flap, namely Kutler flap and Atasoy flap, has proven their worth for fingertip reconstruction over time
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V-Y Advancement flap - for Fingertip amputations
- 2. • One of the workhorse flaps used to resurface fingertip amputations. • Content- Skin Subcutaneous tissue above periosteum and flexor tendon sheath
- 3. • Indications:- 1) Best used for resurfacing of fingertip amputation that is transverse or volar favourable. 2) At least 15 mm of the distal segment of the finger (measured from the distal interphalangeal joint crease) should be available for flap advancement.
- 4. Volar VY advancement – Atasoy - Kleinert Flap Bilateral Lateral VY advancement – Kutler Flap
- 5. Surgical Anatomy:- • Supplied by- by the terminal branches of the digital artery ie anastomotic connections between the terminal branches of the volar digital arteries and the dorsal arches through the fibro-osseous hiatus branch. • In Atasaoy (single midline) Skin and fibrous attachments incised – Terminal branches of digital artery and nerve preserved.
- 6. [1] [2]
- 11. References:- 1. A COMPARATIVE STUDY OF THE SUPRAPERIOSTEAL AND THE SUBPERIOSTEAL DISSECTION IN THE V-Y ADVANCEMENT (ATASOY) FLAP FOR THE MANAGEMENT OF FINGERTIP INJURY - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/The-blood-supply-of-the-finger-tip_fig1_309847871 [accessed 9 Mar, 2024] 2. Authors: Agur, Anne M.R.; Dalley, Arthur F. Title: Grant's Atlas of Anatomy, 12th EditionCopyright  ©2009 Lippincott Williams & Wilkins. 3. VY Advancement, Thenar Flap, and Cross-finger Flaps ; Jin Xi Lim, MBBSa,b,*, Kevin C. Chung, MD, MSc VY Advancement, Thenar Flap, and Cross-finger Flaps Hand Clin 36 (2020) 19–32https://doi.org/10.1016/j.hcl.2019.08.0030749-0712/20/! 2019 Elsevier Inc 4. . Reconstructive Surgery- Principles, Anatomy and Technique- Mathes and Nahai-Volume 1- 5. GREEN’S OPERATIVE HAND SURGERY, EIGHTH EDITIONCopyright © 2022 by Elsevier, Inc. All rights reserved.ISBN: 978-0-323- 69793-4 Volume 1 ISBN: 978-0-323-83397-4 Volume 2 ISBN: 978-0-323-83398-1 6. Flaps and Reconstructive Surgery – Fu Chan Wei ; Samir Mardini- second edition – Elsevier Inc.
Editor's Notes
- There are three facts to remember if a “V-Y” flap is to be raised successfully. First, more problems arise through inadequate mobili- zation than excessive mobilization, and the flap should advance eas- ily into position (Fig. 44.26). Second, only nerves and vessels need be kept intact, making this a “bipedicled” neurovascular island flap. Third, nerves and vessels in the pulp are slender and elastic and will not resist appreciably the movement of the flap. The procedure is done under digital block. 2. Debridement is done. If there is a portion of the distal phalanx protruding beyond the nail bed, the bone is shortened to the level of the nailbed. 3. A triangular flap is designed with the base at the edge of the amputation and its apex at the distal interphalangeal crease 4. The skin incision is made first .5. To get good advancement, the following structures must be divided:a. Fibrous tissue at the apex of the flap (seeFig. 2E)b. Fibrous tissue at both sides of the base of the flap.
- 6. The deep margin of the flap is then separated from the periosteum and the flexor tendon sheath (see Fig. 2F). 7. Using a skin hook for traction at the flap base,identify fibrous tissue that is limiting advancement and divide them (see Fig. 2G). 8. The flap is then advanced and sutured to the nail bed (see Fig. 2H). 9. The proximal portion of the V incision is closed linearly, forming a Y-shaped wound (see Fig. 2I–K).