The anatomical basis of the modified volar advancement flap for fingertip reconstruction

Description: Composite digital-end tissue loss in industry and the kitchen is labeled as a "minor" injury. There are no published data to estimate the social and industrial work-hour losses, and other implications accurately; but by all accounts, there is a disproportionate loss in time, money and aesthetic appearance. At present, the standard of care for such injury is with skin graft or skin flaps by a number of techniques. They are sensate or insensate, local or distant, and often involve complex finger immobilization. Some are also technically challenging. Yet no procedure is widely acceptable that restores both optimal functionality and cosmetic outcome rapidly. We advanced this volar advancement flap (VAF) concept modifying upon the technique described by Moberg1 (1964) and Snow2 (1967). However, unlike them, we used one neurovascular bundle with our VAF. It is safe, simple to do, and reproducible. It may be used in any digit and multiple digits at a time for most types of composite tip loss. It restores a sensate, durable, cosmetically acceptable fingertip with minimal loss of digital length, skill and work-hours. Also, this avoids dorsal skin necrosis, loss of sensation, and joint stiffness as seen with cross finger flap and in other VAF techniques.
We present the anatomical study showing the basis of the concept and tested the VAF in a tertiary hospital based, cross-sectional, consecutive case study series. A larger series of prospective study is recommended.
Somes C Guha, Stephen M. Milner and Amitabha Chanda