Arch Aesthetic Plast Surg.  2017 Oct;23(3):127-134. 10.14730/aaps.2017.23.3.127.

Feasibility and Aesthetic Results of Small Bilateral V-Y Advancement Flaps in the Extremities and Back

• Kim DY
• Choi JH
• Moon SH
• Oh DY

• KMID: 2394318
• DOI: http://doi.org/10.14730/aaps.2017.23.3.127

Abstract

BACKGROUND
Random type small V-Y advancement flap is widely used for facial reconstruction with advantages including good color and texture match. However, the flap is not as widely used in the extremities and back as in the face because of apprehension of the relatively poor vascularity as a risk factor of flap necrosis. We used a small bilateral V-Y advancement flap for the repair of extremity and back defects from various causes. Competent clinical outcomes are described.
METHODS
Between 2007 and 2014, 24 patients (48 flaps) with skin defects in the upper or lower extremities and back were enrolled. The site of the defect was on back (n=6), forearm (n=7), upper arm (n=2), lower leg (n=5), thigh (n=3), and axilla (n=1).
RESULTS
Among the 48 flaps, 47 survived (no event: 42 flaps, total necrosis: 1 flap, partial necrosis: 5 flaps). All partial necrotized flaps healed in 3-4 weeks with conservative care. However, debridement and skin grafting was required for the total necrosis flap. One total necrosis and two partial necroses occurred on the anterolateral side of the lower leg. Two partial necroses occurred on the paraspinal area.
CONCLUSIONS
Contour deformities including central depression and the dog-ear deformity were not observed. Small bilateral V-Y advancement in the extremity and back could be a safe and useful flap, if thick subcutaneous fat and subcutaneous plexus were saved. But areas with thin subcutaneous fat layer, such as the anterolateral lower leg, are poor candidates and carry the increased risk of improper subcutaneous pedicle circulation.

Keyword

Extremities; Reconstructive surgical procedures; Surgical flaps

MeSH Terms

Arm
Axilla
Congenital Abnormalities
Debridement
Depression
Extremities*
Forearm
Humans
Leg
Lower Extremity
Necrosis
Reconstructive Surgical Procedures
Risk Factors
Skin
Skin Transplantation
Subcutaneous Fat
Surgical Flaps
Thigh