“Flap-in-Flap” Technique: Double V-Y Flap in Fingertip Injury Management

Pub Date : 2024-06-05 DOI:10.1055/s-0044-1787278
A. P. Jayachandiran, S. Rajendran, Manoj Ananthappan, S. R. V. Mahipathy, Alagar Raja Durairaj
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Abstract

Abstract Background  Fingertip injuries with amputation are one of the common hand injury problems. Several reconstructive options are available for fingertip injury. V-Y advancement flap is one of the common flaps. In some cases, their advancement capacities are not sufficient to cover the whole defect, resulting in flexion deformity of the distal interphalangeal (DIP) joint, loss of finger pulp shape, or hooked deformity. The double V-Y flap consists of harvesting two cutaneous flaps on the same neurovascular digital palmar bundle. The first V-Y flap is raised as a neurovascular flap and the second flap is an advancement V-Y plasty. Objectives  This article evaluates the outcomes of the double V-Y advancement flap for the fingertip reconstruction. Materials and Methods  This is a prospective study on 19 patients with zone II and III fingertip amputation tip defects between December 2021 and June 2023. The majority were workplace injuries. Results  There were 16 males and 3 females. The average static two-point discrimination was 6 mm. Average advancement of first flap is 8.5 mm and the average advancement of second flap is 4.3 mm. The average total advancement of a double V-Y flap is 12.94 mm (10–15 mm). All of them had “good” total active motion with movement > 210. One patient had flexion deformity at the DIP joint without causing any functional disturbance. All the flaps settled well except for one patient who had superficial partial necrosis of flap which was managed conservatively. Conclusion  This is simple and safe for the reconstruction of zone II and III fingertip amputations with the advantage of like-for-like tissue with near-normal sensation. The second flap increased the advancement of the proximal flap, restoring the pulp shape, and thereby reconstructing a functional and aesthetic fingertip.
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"瓣中瓣 "技术:双 V-Y 皮瓣在指尖损伤治疗中的应用
摘要 背景 指尖损伤导致截肢是常见的手部损伤问题之一。指尖损伤有多种重建方案可供选择。V-Y 推进皮瓣是常见的皮瓣之一。在某些情况下,其推进能力不足以覆盖整个缺损,导致远端指间关节(DIP)屈曲畸形、指髓外形缺失或钩状畸形。双 V-Y 皮瓣包括在同一神经血管数字掌束上采集两个皮瓣。第一个V-Y皮瓣作为神经血管皮瓣,第二个皮瓣作为推进V-Y成形术。目的 本文评估双 V-Y 推进皮瓣用于指尖重建的效果。材料与方法 这是一项前瞻性研究,研究对象是 2021 年 12 月至 2023 年 6 月期间的 19 例 II 区和 III 区指尖截肢尖端缺损患者。大部分患者为工伤。结果 男性 16 人,女性 3 人。平均静态两点辨别力为 6 毫米。第一个皮瓣的平均推进量为 8.5 毫米,第二个皮瓣的平均推进量为 4.3 毫米。双 V-Y 皮瓣的平均总推进量为 12.94 毫米(10-15 毫米)。所有患者的总活动度都 "良好",活动度大于 210。一名患者的 DIP 关节有屈曲畸形,但未造成任何功能障碍。除一名患者的皮瓣出现表皮部分坏死外,其他患者的皮瓣均愈合良好,并接受了保守治疗。结论 这种方法用于 II 区和 III 区指尖截肢的重建既简单又安全,其优点是组织相似,感觉接近正常。第二个皮瓣增加了近端皮瓣的前移,恢复了牙髓形状,从而重建了一个功能性和美观的指尖。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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