Brifish Journalof Phstic Surgery(1990), 43,379-380 Q 1990 The Trustees of British Association of Plastic Surgeons 0007-1226/90/00434379/$10.00 Case Report V-Y advancement flap out of an existing flap R. L. THATTE and N. MOKAL Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Bombay, India Summary-A case is reported in which a large V-Y flap was fashioned out of a flap already present over the dorsum of the hand, to cover a defect created adjacent to it. The V-Y advancement appeared more effective to fill the defect than the traditional method of mobilisation of a part of the flap achieved by dissecting it from its base. Case report Treatment was given in our Unit for an infected crush avulsion injury of the dorsum of the hand, with loss of extensor tendons and fractures of the three central metacarpals, by a staged abdominal flap (Fig. 1). The flap survived in its entirety but there was contracture of the metacarpophalangeal joints in extension. During surgery, when this contracture was released in the area of the scar distal to the flap, a defect was created nearly 2 cm in breadth which had exposed joints in its floor (Fig. 2). It would have needed too much mobilisation of the existing flap to cover the defect and suturing the flap in this fashion would have created tension in the direction opposite to the release. Instead, a large V- shaped flap was fashioned by incising through the existing flap and this V-shaped flap (Fig. 3) was easily advanced over the defect (Fig. 4) without any tension. The patient had a good postoperative result (Fig. 5). Discussion It is not all that uncommon for the surgeon to advance a flap to cover a defect beyond its initial boundaries. Apart from the type of case described here, the commonest situation is probably where the tip of the flap has died. The usual way of doing this is to raise part of the flap from its margins and from its bed and attempt to stretch it. The degree of advancement achievable by this means is limited. The manoeuvre of V-Y advancement described here might become a useful addition to our armamentarium for salvage (Thatte et al., 1983) although its success clearly depends on an adequate secondary blood supply entering the flap from its base. Acknowledgements The authors wish to thank Mr Parshuram Pangerkar for the illustrations and Mrs Chandrashekar for typing the manuscript. References Thatte, R. L., Dhami, L. D. and Patil, U. A. (1983). De- epithelialised turn-over flaps for “salvage” operations. Brirish Journal of Plastic Surgery, 36, 178. The Authors Ravin L. Thatte, MS, Hon. Professor and Head of Department Nitin Mokal, MS, First Year Resident Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Muni- cipal General Hospital, Sion, Bombay. Requests for reprints to: Dr R. L. Thatte. 46 Shirish Co-op. Housing Society, 187 Veer Savarkar Marg. Mahim. Bombay 400 016, India. Paper received 26 April 1989 Accepted 31 August 1989. 379

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Page 1: V-Y advancement flap out of an existing flap

Brifish Journal of Phstic Surgery (1990), 43,379-380 Q 1990 The Trustees of British Association of Plastic Surgeons

0007-1226/90/00434379/$10.00

Case Report

V-Y advancement flap out of an existing flap

R. L. THATTE and N. MOKAL

Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Bombay, India

Summary-A case is reported in which a large V-Y flap was fashioned out of a flap already present over the dorsum of the hand, to cover a defect created adjacent to it. The V-Y advancement appeared more effective to fill the defect than the traditional method of mobilisation of a part of the flap achieved by dissecting it from its base.

Case report

Treatment was given in our Unit for an infected crush avulsion injury of the dorsum of the hand, with loss of extensor tendons and fractures of the three central metacarpals, by a staged abdominal flap (Fig. 1). The flap survived in its entirety but there was contracture of the metacarpophalangeal joints in extension.

During surgery, when this contracture was released in the area of the scar distal to the flap, a defect was created nearly 2 cm in breadth which had exposed joints in its floor (Fig. 2). It would have needed too much mobilisation of the existing flap to cover the defect and suturing the flap in this fashion would have created tension in the direction opposite to the release. Instead, a large V- shaped flap was fashioned by incising through the existing flap and this V-shaped flap (Fig. 3) was easily advanced over the defect (Fig. 4) without any tension. The patient had a good postoperative result (Fig. 5).

Discussion

It is not all that uncommon for the surgeon to advance a flap to cover a defect beyond its initial boundaries. Apart from the type of case described here, the commonest situation is probably where the tip of the flap has died. The usual way of doing this is to raise part of the flap from its margins and from its bed and attempt to stretch it. The degree of advancement achievable by this means is limited. The manoeuvre of V-Y advancement described

here might become a useful addition to our armamentarium for salvage (Thatte et al., 1983) although its success clearly depends on an adequate secondary blood supply entering the flap from its base.

Acknowledgements

The authors wish to thank Mr Parshuram Pangerkar for the illustrations and Mrs Chandrashekar for typing the manuscript.

References

Thatte, R. L., Dhami, L. D. and Patil, U. A. (1983). De- epithelialised turn-over flaps for “salvage” operations. Brirish Journal of Plastic Surgery, 36, 178.

The Authors

Ravin L. Thatte, MS, Hon. Professor and Head of Department Nitin Mokal, MS, First Year Resident

Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Muni- cipal General Hospital, Sion, Bombay.

Requests for reprints to: Dr R. L. Thatte. 46 Shirish Co-op. Housing Society, 187 Veer Savarkar Marg. Mahim. Bombay 400 016, India.

Paper received 26 April 1989 Accepted 31 August 1989.

379

Page 2: V-Y advancement flap out of an existing flap

380 BRITISH JOURNAL OF PLASTIC SURGERY

Fig. 1 Fig. 2

Fig. 3 Fig. 4

Fig. 5

Figure I-A well settled flap on the dorsum of the hand. Flexion at metacarpophalangeal joints is negligible. Figure 2-Defect created to release metacarpophalangeal joints: the fingers are at right angles to the palm after the release. Figure %A V-shaped flap is incised over the existing flap. Figure Q-The Rap advanced over the defect with ease. Figure ?k-On the eighth postoperative day with K wires to fix MP joints, with complete survival of the flap and good healing.