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THE V-Y FLAP
THE V-Y FLAP
Introduction
Pressure ulcers are one of the most common chronic wounds, affecting up to 5% of hospitalized patients.5 They occur due to unrelieved pressure in areas of soft tissue compressed against a bony prominence, leading to eventual local tissue necrosis.105 The treatment of pressure ulcers depends on their stage, though it should be aimed at reduction of pressure, friction and shearing forces, local wound care, and nutritional support.23 There are a variety of options for the surgical management of pressure ulcers, ranging from debridement with direct closure and skin grafting to flap reconstruction.106
Unlike skin grafts, island pedicle flaps maintain their vascular connection at their
base.107 Local flaps are chosen to cover a primary defect when other options are less feasible due to issues with tension, or anatomical form or function.108 Muscle and myocutaneous flaps have been the surgical treatment of choice for deep pressure ulcers due to their ability to occupy dead space and provide cushioning and durability over a pressure-bearing area. However, these flaps may result in large amounts of intraoperative bleeding and may sacrifice motor function in ambulatory patients.109 Reports of success in reconstruction of pressure ulcers are limited to case reports and case series. Furthermore, in a systematic review by Sameem et al., there was found to be no statistically significant difference with regard to complication or recurrence rates among patients with pressure ulcers treated with myocutaneous, fasciocutaneous, or perforator-based flaps.110
The V-Y advancement flap, also known as the island pedicle flap, is a versatile flap with a myriad of applications in dermatologic surgery, from repair of facial defects following excision of skin cancers, to surgical treatment of pressure ulcers.111,112 The classic V-Y flap is a fasciocutaneous flap, meaning it can contain any or all of the tissue constituents found between the skin and the deep fascia, and spares the muscle.113 The general principle involves the creation of a triangular flap that is separated from peripheral skin, forming an island. The vascular supply to the flap remains uninterrupted via a pedicle that retains its attachment to the underlying subcutaneous or myocutaneous tissue.108,111 Throughout the decades, modifications to the V-Y advancement technique have been made to better enhance its mobility and utility.108,109,114โ116