Viciana Enrique J, Lessard Anne-Sophie
Division of Plastic, Reconstructive and Aesthetic Surgery.
Division of Plastic, Reconstructive and Aesthetic Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Fla.
Plast Reconstr Surg Glob Open. 2018 Dec 5;6(12):e2049. doi: 10.1097/GOX.0000000000002049. eCollection 2018 Dec.
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.
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.
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.
阿塔索伊皮瓣或克莱纳特皮瓣为手外科医生所熟知。这种掌侧V - Y三角皮瓣常用于重建伴有骨质外露的指尖离断伤。它适用于横行离断伤或背侧斜形离断伤，可提供具有感觉功能的皮肤和皮下组织区域替代物。最初，该皮瓣不推荐用于掌侧斜形离断伤（掌侧组织损失较大）。通过所描述的改良方法和建议，中度掌侧斜形离断伤可一期闭合，避免二期手术。
通过所描述的技术改良，中度掌侧斜形离断伤可实现闭合。以前可能需要二期手术的损伤现在可一期闭合。
皮瓣掀起最初描述为从远端入路在掌侧骨膜处进行解剖。现在不再推荐这种远端解剖，因为它无法实现推进。比斯利指出为了皮瓣的移动，需要在近端分离垂直纤维间隔。本技术描述强调了这种纤维间隔分离而非拉伸的重要性。强调了对剩余骨质的仔细处理。不推荐覆盖甲床。
