V-Y PLASTY TECHNIQUE  FOR RECONSTRUCTION OF SKIN DEFECTS

*Mehmet Bekerecioğlu, MD
**Mustafa Tercan, MD
*** Önder Tan, MD
****Bekir Atik, MD

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Affiliations Correspondence Introduction Methods

Results Discussion References Table One

Table Two Table Three Figure One Figure Two

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SUMMARY

V-Y  plasty is a  reliable technique used in  covering defects and  wounds or in  lengthening some anatomic  structures. In this study  we presented the results  of 81 patients who  underwent V-Y plasty  operations in different  parts of the body. We  used this technique  for 38 patients in head  and neck region,  23 patients with  pilonidal sinus, 8 patients having sacral pressure sores,  7 patients with  plantar wounds and 5  patients having finger tip  defects. V-Y plasty has been  used everywhere on the body, but less so  in plantar region.  We conclude that   V-Y plasty  is a reliable technique and  can be used for the  plantar  region as well  as the other surface areas of  the body.

 

Key words: V-Y  plasty, Head and  neck, Plantar region, Pressure sores, Skin tumors, Skin defects

INTRODUCTION

V-Y  plasty technique is    common in plastic surgical practice. This technique is  probably described by  Blasius (McCarthy JG, 1990). In  this technique, an  incision  is made as V pattern and the V patterned skin  is approached to  cover the defected  area as Y shape (Fig.1). Most authors  offered the technique as a reliable method for  reconstruction of relatively  small defects (Parry S et al, 1989; Khatri VP et al, 1994).  There are a  great deal of method  to cover defects  in plastic surgery. The V-Y plasty among  these techniques is  the one of  the most reliable  method (Nilson RZ et al, 1995). Although V-Y plasty is a common procedure to cover the  defect it has  limited usage in covering  of lower extremity  defect. Various flaps have  been used to  cover the plantar defect of the foot. Flaps  have been used  to cover the defects in weigh bearing areas. The  covering of the   defects in diabetic  foot must be reliable and let the wound  heal without complication. In this  study, V-Y flaps using in  weigh bearing areas  was emphasized.

METHODS AND MATERIALS

Eighty-one patients were  involved in this  study. Mean age of  the patients was  34.3 (6-72) and male/female  ratio was 2.7/1 (59/22). The unilateral or bilateral using V-Y plasty was  depend on the diameter of the defect. Fasciacutane V-Y plasty was  used to cover the  pressure sores and pilonidal sinus. Prophylactic   antibiotics were given for head and  neck region but  seven days for trunk and  lower extremity. Vacuumed drain was placed to the trunk defects. Of seven plantar defect  of  patient four  were diabetics.

RESULTS

The V-Y plasty was  used in eighty-one patients (Table 1). Location of the defects  in the body are represented  in  figure 2.

Head and  neck region  are  the most suitable  region for V-Y plasty. There was not seen any complication on  this region. Location of the  V-Y plasties on  the head and  neck region are  demonstrated in table 2. The defects consist of skin cancers, traumatic defects, whistling deformity and various  skin lesions (Table 3). Of 25  patients, 17 patients are  basal cell carcinoma (BCC) and 8 squamous cell carcinoma (SCC). 8 patients with traumatic defect (scalp, forehead and eyelid) and 2 patients with whistling deformity of the vermilion were used this procedure.

Of five patients with finger tip defect, one bilateral  and four unilateral  V-Y plasties were  performed.

Seven pilonidal sinuses and six pressure sores were treated by using   bilateral fasciacutaneous  V-Y plasty in the sacral  region. Minimal wound  detachment and seroma  were seen in  the three pilonidal  sinus patients and one  pressure sore at  the postoperative period. Thirty-one patients (pilonidal sinus 23 and sacral pressure sore 8) were treated  in the sacral region totally.

Seven V-Y plasties  were done on  the plantar region. Of  seven patients, four  patients were diabetics. Minimal wound detachment and  infection were determined  in two patients at the  postoperative period.

Discussion

V-Y  plasty is one  of the methods to cover  defects and elongation  of some anatomic  structure (Zook EG et al, 1980). V-Y  plasty has one  session operation,

short  operation time and  a reliable method. V-Y  plasty was used for revision of perioral scar (Yang JY, 1996), columella elongation (Shin KS et al, 1994), treatment of eyelid  defects (Okada E et al, 1997), reconstruction of the orbital region (Johnson CC, 1978), scalp defects (Crabetta I et al, 1994), whistling deformity of  vermilion (Kapetansky KI, 1971). V-Y  plasty was mostly used for  head and neck region  in our cases (% 46.9). There was no complication in this region. Of  38 patients, 15 have malar region (% 39.5), 7 have buccal  region (18.4), 5 have nasal dorsum (%13.1), 4 have eyelid defect (%10.5), 3 have whistling deformity of vermilion (%7.9), 2 have defect in the forehead region (% 5.3) and 2  have scalp defect (%5.3). Histopathologic examinations of 28 patients, 17  patients were BCC (% 56.7), 8 patients were SCC (26.7), 2 patients were nevus sebaceous (% 6.6) and 1 patient was intradermal nevus (% 3.4). Follow up of the tumors of  head and neck  region is the mean  16.8 months (between 11-27 months). The role of V-Y  plasty in the  treatment of pilonidal  sinus has been  presented (Dilek ON et al, 1998). Khatri et al were reported good  results of treatment of recurrent pilonidal sinus with V-Y plasty (Khatri VP et al, 1994). The bilateral fasciacutaneous  V-Y plasties were  performed in 23  patients (% 28.4) for pilonidal  sinus treatment. Minimal complications were seen such  as infection and seroma  in 3 patients. No recurrent  was seen and good  results were achieved  in these patients. Fasciacutaneous V-Y plasty  has been performed  with good results   for sacral and  gluteal (Wechselberger G et al, 1997; Lee HB et al, 1997). V-Y plasty  is also performed  for Dupuytren contracture in upper  extremity (Mahaffey PJ, 1996). One  of the treatment method of  fingertip defect is  V-Y plasty (Frandsen PA, 1978; Atasoy E et al, 1970; Shepard GH, 1983). Five  patients with fingertip  defects operated for fingertip  defect (% 6.2). V-Y plasty is used for  perianal reconstruction (Sagher U et al, 1992). Reconstruction of lower  extremity defects, especially weight bearing  areas, needs special  attention (Yaremchuk MJ, 1989). Reconstruction with a flap is mandatory. V-Y plasty is also  used for lower extremity (Maruyama Y et al, 1990). 

Using V-Y plasty  in the plantar region  is rare (Colen LB et al, 1988). Diabetic patients especially  has limitation when  the wound located  on the weight bearing area. Of seven  patients, four were diabetics. Wound infection  developed in two  patients. There were no complications seen in remaining  patients who had operations in the plantar  region.

Finally, V-Y plasty is a reliable method that  can be usedalmost everywhere  on the body surface  and also seems as  reliable for  the plantar region.   

  

REFERENCES

 

1.      Atasoy E, Ioakimidis E, Kasdan MD, et al. (1970) Reconstruction of the amputated finger tip with a triangular volar flap; a new surgical procedure. J Bone Joint Surg 52A: 921-925.

2.      Colen LB, Replogle SL, Mathes SJ. (1988) The V-Y plantar flap for reconstruction of the forefoot. Plast Reconstr Surg 81: 220-227.

3.      Crabetta I, Drazan L, Skricka T, Perrotta F. (1994) The V-Y surgical flap vascularized by the musculoaponeurotic layer for covering scalp defects. Rozhl Chir 73: 389-391.

4.      Dilek ON, Bekerecioglu M. (1998) Role of simple V-Y advancement flap in the treatment of complicated pilonidal sinus. Eur J Surg 164: 961-964.

5.      Frandsen PA. (1978) V-Y plasty as treatment of finger tip amputations. Acta Orthop Scand 49: 255-259.

6.      Johnson CC. (1978) Epicanthus and epiblepharon. Arch Ophthalmol 96: 1030-1033.

7.      Kapetansky KI. (1971) Double pendulum flaps for whistling deformities in bilateral cleft lips. Plast Reconstr Surg 47: 321-324.

8.      Khatri VP, Espinosa MH, Amin AK. (1994) Management of recurrent pilonidal sinus by simple V-Y fasciocutaneous flap. Dis Colon Rectum 37: 1232-1235.

9.      Lee HB, Kim SW, Lew DH, Shin KS. (1997) Unilateral multilayered musculocutaneous V-Y advancement flap for the treatment of pressure sore. Plast Reconstr Surg 100: 340-345.

10.Mahaffey PJ. (1996) V-Y plasty for Dupuytrens contracture of the palm. JR Coll Surg Edinb 41: 425-428.

11.Maruyama Y, Iwahira Y, Ebihara H. (1990) V-Y advancement flaps in the reconstruction of skin defects of the posterior heel and ankle. Plast Reconstr Surg 85:759-761.

12.McCarty JG. Introduction to Plastic Surgery, In: Plastic Surgery, Mc Carty JG, May JW, Littler JW (eds), Philadephia, WB Saunders Company, 1990, pp: 65-66.

13.Nilson RZ, Dockery GL.( 1995) V-Y plasty and its variants. J Am Podiatr Med Assoc 85: 22-27.

14.Okada E, Iwahira Y, Maruyama Y. (1997) The V-Y advancement myotarsocutaneous flap for upper eyelid reconstruction. Plast Reconstr Surg 100: 996-998.

15.Parry S, RC: Park and Park. (1989) Fasciocutaneous V-Y advancement flap for repair of sacral defects. Ann Plast Surg 22: 543-546.

16.Sagher U, Krausz MM, Peled IJ. (1992) V-Y plasty for perianal reconstruction after resection of tumor. Surg Gynecol Obstet 175: 31-32.

17.Shepard GH. (1983) The uses of lateral V-Y advancement flaps for fingertip reconstruction. J Hand Surg 8: 254-258.

18.Shin KS, Lee CH. (1994) Columella Lengthening in nasal tip plasty of Orientals. Plast Recontr Surg 94 :446-453.   

19.Wechselberger G, Schoeller T, Otto A, Papp C. (1997) Gluteal fasciocutaneous V-Y advancement flap. Plast Reconstr Surg 100: 1938-1939.

20.Yang JY. (1996) Intrascar excision for persistent perioral hypertrophic scar. Plast Reconstr Surg 98: 1200-1205.

21.Yaremchuk MJ. Flap reconstruction of the foot. In: Lower Extremity Salvage and Reconstruction, Yaremchuk MJ, Burgess AR, Brumback RJ (eds), New York, Elsevier, 1989, pp 181-190.

22.Zook EG, Van Beak AL, Russel RC, Moore JB. (1980) V-Y advancement flap for facial defects. Plast Reconstr Surg 65: 786-789.

   

Table 1. Locations  of V-Y plasty.

Areas	n	%
Head and neck	38	46.9
Pilonidal sinus	23	28.4
Sacral pressure sore	8	9.8
Plantar ulcers and defects	7	8.7
Finger tip defects	5	6.2
Total	81	100

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Table 2. Location of V-Y plasty in head and neck region.

Areas	n	%
Malar region	15	39.5
Cheek	7	18.4
Nasal dorsum	5	13.1
Eyelid	4	10.5
Vermillion	3	7.9
Forehead	2	5.3
Scalp	2	5.3
Total	38	100

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Table 3. Location of lesions in head and neck region.

Lesions	n	%
Basal cell carcinoma	17	56.7
Squamous cell carcinoma	8	26.7
Nevus sebaseus	2	6.6
Intradermal nevus	1	3.4
Whistle deformity	2	6.6
Total	30	100

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Figure 1: Schematic diagram of  V-Y plasty procedure.

 

  

 

  Figure 2: The  location of the whole   V-Y plasties on  the body

 

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