Anatomical research and clinical application of multistage advancement in dorsal finger V-Y flap

Objective: To investigate the anatomical basis and clinical efficiency of the advancement distance in dorsal digital V-Y advancement flap. Materials and methods: Thirty-four fingers in 11 fresh adult hand specimen were selected, V-Y flap was performed with the digital artery as vascular pedicle, and the advancement distance was measured. The relationship between the distance and extensibility of skin, sliding degree of subcutaneous superficial fascia, angular displacement of digital arterial dorsal branch, elasticity of digital artery was discussed. Two cases were provided to demonstrate the feasibility and importance of this flap. Results: In the dorsal digital V-Y advancement flap simulated on fresh adult hand specimens, the mean advance distance of the middle segment flap and proximal segment flap is 18 ± 0.8 mm and 34 ± 1.7 mm, respectively, and the maximum can reach 24 and 45 mm, respectively. Two cases of dorsal digital V-Y advancement flaps were designed and performed in the dorsal side of the ring finger middle segment and the thumb proximal segment, respectively. The advancement distances were 25 and 26 mm, respectively. All flaps survived completely and the incisions healed by first intention. The flap texture was good, the affected finger was symmetrical, and the activity and sensation restored well. Conclusion: The dorsal digital V-Y advancement flap with the digital artery as the main vascular pedicle can exert four factors for advancement effect, and significantly increase the advancement distance. The operation is simple, the blood supply is reliable, and the postoperative sensation is normal. It is an ideal flap for repairing the digital dorsal defect.