Reconstructionof the Triangular A NEW Amputated Volar SURGICAL M.D.t, M.D4, M.D.t, Finger Flap Tip with a PROCEDURE* EVANGELOS JOSEPH E. LOUISVILLE, IOAKIMIDtS, KUTZ, M.D4, AND BY EISDOGAN MORTON HAROLD L. E. ATASOY, KASDAN, KLEINERT, M.D.t, KENTUCKY Fi-oni 1/nc Department of Surgery, University of Louisville School of Mc(licine, Lou isnillc Amputatious reconstn-uctions of the is nseeded flnsger procedure skins tip is a common maximum insjury funsctioni ssusd good ansd judgmeust its surgical loss of time to preserve with to miusimize frons usually svonk. The well ideal I)added sisould nsormal mainstaiti senisatiots. letsgtis without anid normal cover the defect witis Evets nsons-tensder, Previously described ussethods provide good paddinsg ansd coverage unscommots but seussatioui14. or abseist with Icutler’s its the smaller procedure, it is tsot lateral triansgles. to fitid diminished seussatioti Transverse Oblique Oblique Dorsal FIG. Palmar amputations. 1 of finger-tip Three commonest types The for procedure we whets describe the tlse distal platse here, called the triansgular volar ansd thse flap, bonse was is developed reconsstructious phalanx is amputated cats loss be applied is extenisive to most and finger-tip amputations, of amputatious except is those iticlinsed exposed. ins w’hsichs the soft-tissue volarward-an oblique It palnian’ anisputatiots be shsortened (Fig. 1). Occasionsally, the remainsitsg part of the ihsalansx has to a few- millimeters in order phalatsx of to facilitate can be treated provides Society for the good procedure. by this method constour of the Amputatiotss ins order ansd hand, through maiustain * the Head middle at the Alinnnal or proximal leusgth. The Meeting to maximum 17, of procedure the American paddinig Chicago, Surgery \ledicine School Illinois,January t Depaitment 40202. Former 1971). ‘utgems ill Surgery Unstvetsnt of of Lout to l)r. ville School of of Louisville of Medicine. Kentuck Lotuisville, 921 Reprint Kentucky VOL. 52-A. Fellow requests 40202. 5, JULY the 1-land, University directed Ata.soy, should be Louisville 1001 1)octors Building, NO. i970 922 ERDOGAN ATASOY ANI) ASSOCIATES FIG. 4 atid (-losure of (lefect. Advaticemenst 3 flap. Skits ilicisioli atid mobilization of triangular FIG. thse apex of the triangle sisould be placed THE JOURNAL OF BONE AND JOINT SURGERY . This base as the amputated edge of usail niatrix. 1). is exsansguiusated from tise finsger ausd is a Blood drains is applied edge same of to the skits w-idtls base w’here of the fiusger as a tournsiquet. \‘-Y techtiique. If the phsalanix. using preparatious. 2 of Fnu. thse nail shsould be covered approximations method utsless the bonse is shortetsed sufficiently Technique Metacarpal performed small thse triansgle at before Petsrose is the least block wound cut the ausesthiesia. amputatiouss oblique of the triatsgle niost suitable the matrix. of the dorsal finger oblique tip and. ouses exposed for this boise to procedure permit In cases by some of the of volar other base aniputatiouss. Thse base of should be ansputatiots is through the distal tise amputations has occurred. 1 per ceust plaits lidocaiuse hsydroclsioride. triangular flap. l)ueseri’es normal sensations. most importaust nure the (pad) to of all. Suture base of triangular flap to nail bed withs less Transverse scarring and (Fig. NO. or occasionsally 3 and 4). 5-F at tIm (listal flexious crease. 5-B A 1. The V incision oti the palmar aspect plsalanLx cans be defatted is thsens closed covered w’ith to cover the by convertinsg a Wolfe graft defect. sustaimsed an amputatioti of the tip of . 5-D FIG. 52-A. ansd flexor tensdon (smootlsitsg Separations of tise fibrofatty slseaths aids mobilizations of tlse sharp edges is sutured of the distal (Fig. 2). the flap is advausced over bonse and the base of thse triatsgle the nsail bed with 6-0 nsylors sutures. it to a Y (Figs. JULY 1970 male machine Cases operator. 5-E FIG. VOL. The densuded nail bed a portion of the flap can be Illustrative F..T. FIG.RECONSTRUCTION OF THE AMPUTATED FINGER TIP 923 FIG. 5-A FIG. a thirtv-seven-yeal--old 5. After miusinsuns d#{233}bridemetst of tIm stump of the to boise etid). sitice it is easier to advance thiroughs a lonsger the flap.N. This distally based The the triangular neives flap tissue flap is developed vessels from periosteum by cuttinsg of the onsly full thicktsess of skits. of ansd blood subcutanseous flap are preserved. 5-C FIG. . 6. 6.. 6-I) Fie. 6-A Fn(.C Fue. TIlE JOURNAL OF BONE AN!) JOINT SURGERY .B I’’ LML1 Fme.924 ERDOGAN ATASOY ANt) ASSOCIATES Fit. Umider the procedure.. ims ut door by 6-F). 2.: The Cross Filigel 1951. Two available finger All for patiensts had evaluatiots at was follow-up. Am. JULY 1970 of Finger-Tip of Amputated Injuries. 1). 5.si: fingers comistructed through the finger tip amid the cosmetic result at follow-up were excellent (Figs. 1). Finger Britisis Tips.RECONSTRUCTION OF on THE AMPUTATED FINGER TIP of 923 the distal volar pisalnuix. ansd less the paitiful result sitice it is tiot with locatcd good is excelletit finger-tip sensation out Metacarpal tournsiquet. 5. Plast. fifty-four times. T. Otsly its other Most a simple flaps is adequate important. Surg. 2. the atsd study ensd of the flap which with hypersenssitivity withins are result cases old a few in which later weeks the epithelized. is advatsced is closed exposed approximated by consvertinsg References T. flap pro- the left long Under finger by block ims a shear machine August 20. finger atid grafts. %V. Surg. fortyots the ansd I)hsalai5 The procedure five was times. distal one-third block The result of the anesthesia. 1969. Its tisese was Advantages of the V-Y procedure is mitsimum Cosmetically. at the edge dystrophy treatmenst ins this cases. CIS0NIN. eighty-five distal Thsere were times. BARCLAY. procedure The j)atienst nsale was fourteens sevensteens nsonsths female atsd tise oldest patients. was right the excellent long tips and were ring re- axillary volar-flap (Figs. coistour of the block ansd finsger as padditsg. 17: 1956. sixty-otse patiensts affiliated w-itls hospitals. of recotsstructinsg unsatisfactory also excelletit. at usilsg a thsree-year-old home the on August triatsgular girl. K. All but isad later Tlsere tsormal gradually is-crc senssations its whom setsatiots isad itsitiahly motions lost atsd tsormal tise ficial sonic to appearansce skits necrosis sympathetic Not included method of the flusger was excellenst. J. recotistructed amid lost otse-third with the metacarpal Selisation anesthesia. botse it to has be ots beets applied the used to volar prepared successfully most side of with to finsger the the instact for the recotistructioti except fitsger atid blood The tip. those The supply. It is simple directly over the tt) perform. Plast. performed atsd ons the ots thse proximal Results Fifty-six of tise sixtv-otse except to returned I)atiensts for isearly two were nsormal. and Ilecomistruct.: The Late Results H. 8: 38-43. 52-A. of tue flnsger the hsyperesthesia area of superThree patietsts had tip. V itscisions of amputatiotis amputated tserve matrix. sixty-four flisger at youtsgest at differetst of levels had Medical their Center finsgers and reconsstructed years phalanx phalatsx five by this old. NO. nsail extetssive over carefully ansd a V.: Reconstructiomi 44: 349-352. . through C. utilized amputa- cotsservative V-V procedure painsful as ans elective tionis. Surgeon. Thsis responsded had was finger-tip subsided.. L. the tip was triamigular cedure. Flap: A New Method of Repair. tip. 6-A Material From amputationss tise onse middle Unsiversity September 1967 Louisville to October 1969. anid the dressinsg thereby a small procedure atsd guard lessensinsg Petsrose preserves is required joitit draits suffices nsormal withstifftsess. as a immobilizatiots atsesthiesia Summary A amputated with distally triatsgular finsger based volar tips. 419-425.. 1. 3. patietstt a small tso serious complicatiotss. amputated 1969. 5-A 5-F). VOL. 1968.. BFasLl:Y. cud of thse Scar fitiger. soft-tissue triatsgular It flap cats loss flap. FL. FmsHEu. . ansd do not need repetitiots. The advatstages claimed by the authors are by their results.. The and Use of a Volar Flap Reconstruct. 1959. S. same Association is an principle in have adaptation triangular-flap ins the just have ly. MICHAEL. prinsciple repair.. U. Clin. Mar. Atsesthesia WILLIAM: for Upper Extremity for Finger Surgery.ed covering the bone end and reconstituting the finger tip . K:msi. lI0LMES. 1967. Surg. Orthop. 1968. IIADDAD. E. Corssel-ving Bony J. and (iRANTHAM. J. the small proximal residual skin defect. L. E. Plast. NEw surgery which at one YoRK: of the of Dr. 1950. 57 Method of Repair : 346 of Fingers for 347.: Repair of Traumatic Finger Tip Amputations. admitted add. of Fingertip 1967. by other methods of repair. One disadvantage. a Soft H. S. E. by to I might medial like to indicate methods of using local tissue to repair such defects. Surg. 1)EJ0NGH.. 7. 14. J. EDwIN: ERDOGAN ATASOY AND ASSOCIATES A Simple Tissue Pad. II. J. resulting in the loss of the nail. DESIMONE. A. 5 : 368-371. W. shortening of the boise by only three to five millimeters allows direct approximation to the msail base and this method may be as effective as the one presented by the authors. careful d#{233}bridement resulted in two flaps nail base. The Kutler Plastic Procedure Forming 5. M. Trauma.: Plast. A.. atsd PANGMAN. 1942. succinctdiagrams and photographs. J.: Regionial KUTLER. atsd with clear and the follow-up well substantiated advaistage not stated the series briefly. Bone and Joitit Surg. Tip for Repair 40 : 163-168. nail base. J. have been clearly stated. J. 133 : 29-30.. For the lateral oblique tissue loss including part of the nail. Surg.. J. E. another WILLIAM METCALF. Am. Feb. Here an ilicisiOni ins the sulcus opposite the injury allows development of a flap to cover the bone (after trimming the little spike) atsd a small graft completes the repair. A major series of cases. 11. J.. The local complication rate ha. For the dorsal oblique tissue loss. E. 1953. H. A.. . H. KLEINERT. he of our Dr. . Surgeon.: Finger Tip Injuries and Their Maniagensent. J. Med. 4: 877-882. DISCUSSION 1)R. 1969.: Volar-Flap Advancemetit for Thumb and Fimiger Tip Injuries. 66: 109-112. Southerts Met!. American surgery. Armed Forces Med. BRONX. lateral loss or incisions skin is defects required the inapplicability oblique losses. the pitlp. H. digital Flaps. ARNOLD. 1957.. Boise Tissue and and Joint of Fitsger-Tip Ansputatiolis. For volar oblique in each paronychial sulcus allow the two resulting flaps to be ilsterdigitat. A Pieliminary A New Method 1947. R. 3 : 3-12. KENNETH. W. well Kutler’s described meetings Ata. S. about one centimeter its diameter. 10. A split graft covered the small regrown nail and nicely contoured finger which were interdigitated and supported residual defect.: 317-321.926 4. and Reconstruct. GASPAR. H. Report. Jis. and KASDAN. Amptttatiolss: 1963. Ans. 49-A: 6. Surg..s’r’r.soy knowns bilateral and his associates tried of years have demonstrated its plastic having Medical the useful It basic They applicatiots imagitsative ansd atsd 1947 treated to hatsd applicatiots discussed a sizeable ansd well Journal a few presented V-Y the ago.s beens at a minimum results are eminently satisfactory. 13.. Assn. is covered with a split graft. and they by the authors is that the method obviates the need for split-graft coverage of residual the authors. J. The Thenar Flap. Amputation. The result about ten tip. of the method to volar oblique loss of tissue. 61 1264-1267. 12.: The Repair of Surface Defects of Finget’s by Trans- 9. KLEINERT. SNOW. 25 : 41-51.: Am. the V-Y procedure again is not applicable. the remaining later was a THE JOURNAL OF BONE AND JOINT SURGERY . In a crushing injury. L. 39-B : 80-85. H.: The Kutler Repair of Fingertip Amputation. alsd weeks I would the bone tuft. (UmunmN. freely atid.