V-Y “Cup ” Flap for Volar Oblique Amputation of Fingers

For fingers left shorter volarly after finger-tip amputation, a volar V-Y amputation flap designed with the V-Y portion at the middle phalanx level and using the Snow cupping technique for reconstruction of the pulp and tip has provided good sensation, padding and contour. Hypersensitivity and beaking of the nail have not been problems. It is difficult to provide satisfactory cover for fingertip amputations in which the stump is shorter volarly than dorsally. This paper describes a local flap which has been helpful in closing such amputations. The flap combines the volar V-Y advancement principle with a technique described by Snow (1967) which produces a well-contoured fingertip with good sensation. When Atasoy (1970) described the very helpful volar triangular V-Y advancement flap for closure of fingertip amputations, he noted that the flap is not useful in amputations in which the stump is shorter volarly than dorsally, because it cannot be mobilized enough for its leading edge to reach the end of the amputation site dorsally. In 1967 Snow described coverage of distal amputations of fingers by the volar advancement flap previously published by Moberg (1964) for thumb amputations. Although Snow did not stress it in the text of the article, his illustrations show a technique for cupping the distal end of the flap which neatly solves the problem when there is greater volar loss. The dorsal ends of the flap next to the nail bed margins are brought together to form a cup of the end of the flap (Fig. 1). Because these two points of the flap are at the distal level of the amputation stump, the flap must advance only a short distance to cover the end of the stump. The volar end of the flap, instead of requiring advancement to the end of the amputation stump, becomes a dog-ear which adds bulk, paddin