VOLAR V-Y ADVANCEMENT FLAPS IN RECONSTRUCTING FINGERTIP INJURIES

Fingertip injuries with exposed bones and joints require immediate or early closure for the preservation of function and avoidance of complications. The ideal procedure should maintain the length of the finger and cover the defect with non-tender, well-padded skin with normal sensation. The aim of this study was to evaluate the role of the different types of volar V-Y advancement flaps in reconstructing and resurfacing injuries of the fingertips at different levels and angles. Thirty patients (N=30) sustaining fingertip injuries of variable etiology and lost components, type III & IV according to Allen’s classification were divided into two groups (n=15) according to the extent of tissue loss.V-Y Volar flap has been used for patients of group I; Neurovascular V-Y Advancement Flap for patients of group II. All subjective complaints (tenderness, cold intolerance and incomplete extension) were resolved within six months of follow up. With respect to the complications there were no statistically significant difference in except for light touch examination. The simple V-Y volar advancement flap, with apex at DIP, and the neurovascular V-Y advancement flap, with the apex at PIP can be used in Allen III and IV types of fingertip injuries. The choice of either flap depends on the direction of injury. The former is better reserved for the dorsally-directed tissue loss. The latter is preferably used in either the volarly-slanting tissue loss or the perpendicular(guillotine) fingertip amputation.