Sungur Nezih, Kankaya Yüksel, Yıldız Kaya, Dölen Utku Can, Koçer Uğur
1st Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara Training and Research Hospital, Plevne Cad., Altindag, Ankara, Turkey.
Hand (N Y). 2012 Mar;7(1):79-85. doi: 10.1007/s11552-011-9389-6. Epub 2012 Jan 19.
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.
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.
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.
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.
指尖离断是上肢最常见的损伤类型。指尖离断重建的目标包括覆盖缺损、建立最大程度的触觉辨别力、保留手指长度、保护关节功能、获得有良好衬垫的指腹组织、为指甲生长提供床面、获得满意的外观并使患者尽快恢复工作。相邻的皮肤和软组织是指尖损伤的最佳覆盖物。然而，局部同指皮瓣缺乏足够的组织来覆盖缺损。为了解决这个问题，我们在指尖离断中双侧使用V-Y旋转推进皮瓣，该皮瓣满足所有重建目标。旋转加上推进使该皮瓣更具灵活性，更易于覆盖所有离断平面的较大缺损。
2007年至2009年期间，我们对7例男性患者（平均年龄37.6岁）不可再植的指腹进行了双侧V-Y旋转推进皮瓣手术。
7个手指制作了14个皮瓣。皮瓣无全部或部分坏死。患者既无冷不耐受也无瘢痕过敏。未发生近端指间关节僵硬。保留甲床的患者未出现明显的钩甲。由于皮瓣包含神经血管束，手指术前和术后的感觉和血运无差异。捏物无痛，结果满意。
除了各种多样的指尖重建方法外，我们想介绍V-Y旋转推进皮瓣作为一种快速、可靠且美观的方法。
