Indications
Classically, this flap is indicated in patients with transverse or volar oblique amputations.
In actuality, the patient in whom this flap is useful generally will have an amputation where there is more tissue on the radial and ulnar margins of an amputation and exposed distal phalanx.
Limitations
Generally, the flap does not allow for advancement of more than 3 to 4 mm, and there is a sagittal scar placed on the tip of the finger.
Technique
1. The injured area is debrided and bone spikes trimmed.
2. V-shaped incisions are made on each side of the fingertip and carried down through the subcutaneous tissue.
- Dorsal edges of the 2 flaps begin 1-2 mm volar to the edge of the fingernail and extend volarly 7-8 mm.
- Apex of the “V” flap sits just distal to the DIP crease.
3. Base of the triangular flap produced is held by a fine skin hook, and with sharp-pointed scissors the fibrous strands holding the skin to the bone are palpated and divided, so retaining a soft pedicle containing the neurovascular supply.
4. Flaps are sutured together over the fingertip and remaining defects are closed as a V-Y repair. However, it is not necessary to close the skin centrally over the fingertip as long as there is good soft tissue closure over the exposed distal phalanx.
Refereces:
- Gaber M. Kutler repair for the amputated fingertip. Ann R Coll Surg Engl. 1979 Jul;61(4):298-300. PMID: 475275; PMCID: PMC2492195.
- Chao, J. D., Huang, J. M., & Wiedrich, T. A. (2001). Local hand flaps. Journal of the American Society for Surgery of the Hand, 1(1), 25–44. doi:10.1053/jssh.2001.21783
- https://youtu.be/ZwrbhW_1mnU
