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The perioral region is the most important area for facial expression, after the periocular structures. For the reconstructions of this region, an aesthetic outcome is as important as functional results in terms of the patient’s social life. The purpose of this study was to discuss the functional and aesthetic outcomes achieved with transversely advanced V–Y flaps in reconstructions of the perioral region. The study included 17 patients in whom transverse V–Y advancement flaps were used to repair full-thickness perioral defects resulting from malignant tumor resection. The patients were evaluated in terms of functional and aesthetic outcomes, complications, and need for revision surgery. To evaluate postoperative outcomes, a control group with no history of surgical interventions to the lips or perioral region was selected. Measurements of the lower and upper lips, mouth opening height, and mouth opening width were obtained from the controls and postoperatively from the patients. Lower lip reconstruction was performed in 13 patients (76.4%) and upper lip reconstruction was performed in 4 patients (23.5%). Total lower lip reconstruction was performed in 3 patients. Postoperative measurements were statistically equivalent to those of individuals with no surgical history. No cosmetic deformity formation or microstomia which require surgical treatment were observed in any of our patients. This technique is a simple, useful, functional method with short procedure time and satisfying aesthetic outcomes for patients with total or partial lower and upper lip defects. Level of evidence: Level IV, therapeutic study.

Objectives This study aims to report the outcomes of dorsal V-Y advancement flap technique used for the reconstruction of surgical defects following total matricectomy performed for the onychogryphosis of hand nails. Patients and methods A total of 18 consecutive patients (10 males, 8 females; mean age 38.4 years; range, 24 to 41 years) with 20 onychogryphotic hand nails who underwent total matricectomy and dorsal V-Y advancement flap technique were analyzed retrospectively between June 2015 and March 2018. The Mann- Whitney U test was used to compare the pre- and postoperative Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) questionnaire scores while postoperative satisfaction rate was also evaluated. Results The mean follow-up period of the patients was 15.3 months. The etiology was finger trauma in eight and surgical complication of recurrent paronychia drainage in four cases, while the remaining six were idiopathic. The mean time to return to work was 5.2 weeks, and the mean pre- and postoperative Quick DASH scores were 0.97 and 3.45, respectively, with a statistically significant difference. The postoperative satisfaction was rated as excellent in 16, good in one, and moderate in one case. Conclusion The dorsal V-Y advancement flap technique can be performed reliably due to its good soft tissue coverage, satisfactory cosmetic and functional outcomes, and allowing a short time to return to work.

Objective: To find a safe repair site for a proximal mini-incision to expose the fascia at the level of the gastrocnemius medialis (GM) myotendinous junction (MTJ). Methods: Seventeen anatomic specimens of popliteal fossa, leg, and foot fixed in formalin were dissected, and the perpendicular distance from the apex of the medial malleolus to the GM MTJ was measured. Results: The minimum and maximum perpendicular distances from the apex of the medial malleolus to the GM MTJ were 14.00cm and 20.5cm, respectively. Average distance was 16.56cm. Conclusion: We were able to establish a constant value and the average GM MTJ height, which allows for V-Y lengthening through 2 mini-incisions. In reviewing the literature, there was no description of the approaches proposed in this study. Level of Evidence VI; Therapeutic Studies; Case Series.Achilles tendon/surgery

Background Since the 1900s, many methods have been developed to correct the epicanthal fold. Increased use of epicanthoplasty has yielded unsatisfactory results. Objectives To describe a method of epicanthal fold reconstruction using V-Y advancement and turnover flap for clinical application. This method is simpler than conventional surgery. It is easy to perform with excellent esthetic results. Methods The authors performed medial epicanthal fold reconstruction in 82 patients (16 males and 66 females) between April 2014 and September 2017. All patients enrolled in this retrospective study underwent surgical procedures at the authors' institution. Interepicanthal distance was the distance between medial epicanthal folds. It was measured with a surgical ruler. Results Before surgery, mean interepicanthal distance was 35.4 mm. Using our surgical technique, successful outcome was achieved in 79 (96.3%) patients with satisfactory results. The mean distance between the medial epicanthi post-surgery was 38.6 mm, increasing the total length by 3.2 mm without showing any major postsurgical complications. Discussion Epicanthal fold reconstruction using V-Y advancement and turnover flap is a simple and effective technique that can readily improve the frontal view. It improves periorbital contouring, makes eyes look natural without fully showing the caruncle, and yields excellent esthetic results. In particular, there were no major visible scars following eversion suture.

We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferentially to the dorsal aspect with loss of the skin of the terminal phalanx and part of the proximal phalanx. The nail and germinal matrix were lost with exposure of the bone and extensor pollicis longus tendon insertion. The thumb was totally covered with a combination of two flaps: Moberg flap with V-Y advancement was used to cover most of the volar surface of the thumb and reverse adipofascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Three weeks later this flap was divided and the thumb was mobilized freely. The patient had a full range of movement of the thumb and index finger with few settings of physiotherapy postoperatively. We recommend combining both of these flaps to reconstruct degloving injury of the thumb as they provide near adjacent tissue of similar texture, preserve sensation at the volar aspect of the thumb and also avoid the complications of the distant flaps.

Chronic Achilles tendon ruptures typically are treated with surgical intervention except in low-demand patients or patients who are unable to tolerate surgery. Although several treatment strategies are described, most literature is case reports and case series. There is no widely accepted algorithm or gold standard for surgical treatment of chronic Achilles tendon ruptures. Treatment strategy depends on the size of the tendon gap after excision of nonviable tissue and scar tissue. Smaller gaps can be treated with direct end-to-end repair. Medium-sized gaps can be treated with tendon-lengthening procedures. Tendon transfers, autograft, allograft, xenograft, and synthetic grafting are described for the reconstruction of large defects.

The traditional V-Y advancement flap for fingertip reconstruction has limitations such as the flap flexibility and distance for advancement. The aim of this study was to design a modified flap to obtain a greater advancement and to provide a far superior cosmetic result. From October 2016 to November 2017, 21 patients underwent the modified flap for fingertip defects reconstruction. A bipedicled bridge type combined with V-Y advancement flap was designed to obtain a greater advancement. We also improved the way of nail groove reconstruction and nail bed lengthening. All the patients were followed up for a minimum of 6 months. All flaps healed with satisfactory pulp and nail contour. All patients were satisfied with the cosmetic appearance and no complications were encountered. The distance of flap advancement can reach to more than 1 cm and flap size can also be larger than 1 cm2. The modified bipedicled bridge–type V-Y advancement flap has simple and acceptable modifications for fingertip reconstruction.

Background The mental V-Y advancement flap method is useful for reconstruction of lower lip defect because of its many advantages. However, it is not easy to select the optimal reconstructive method for the vermilion defect that remains after application of the mental V-Y advancement flap. In choosing the representative surgical method for vermilion mucosal reconstruction including mucosal V-Y advancement flap, buccal mucosal flap, and buccal mucosal graft. We describe an efficient technique to large lower lip defects combining mental V-Y advancement flap and buccal mucosal graft. Methods This study included 16 patients who underwent reconstructive surgery for full-thickness and large defect (> half the entire width) of the lower lip from October 2006 to September 2017. The operation was conducted using mental V-Y advancement flap with various vermilion mucosal reconstruction methods considering the location of the defect and the amount of residual tissue of the lip coloboma after excision. Results All patients underwent mental V-Y advancement flap. In vermilion mucosal reconstruction, five patients underwent mucosal V-Y advancement flap, three underwent buccal mucosal flap, and eight underwent buccal mucosal graft. There were good aesthetic and functional results in all patients who underwent buccal mucosal graft. However, two patients who underwent mucosal V-Y advancement flap complained of oral incompetence, and all patients who underwent buccal mucosal flap had oral commissure deformity. Conclusion Buccal mucosal graft combined with mental V-Y advancement flap can produce suitable functional and aesthetic outcomes in near total lower lip reconstruction in patient with large mucosal defect including vermilion portion.

Pressure Injuries (PIs) are described as “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear [1]. The pathology remains frequent in hospital settings despite the progress made in prevention which represents the optimal management of this pathology [2]. Clinically, they can cause severe pain, serious physical and psychological discomfort often leading to prolonged hospitalization and poor quality of life in the daily clinical practice [3-6].

Achilles tendon ruptures are a common ailment and often missed in upwards of 25% of cases. Neglected Achilles injuries can be treated both conservatively and surgically. Physical therapy, bracing, and custom ankle-foot orthoses are some options to consider. Surgically, there are many options, depending on the quality of the existing tendon, size of the defect, and the surgeon's comfort with the technique. Those procedures include primary repair, V-Y tendon advancement, turndown flap, tendon transfers, and other allografts. These techniques have been shown to have good to excellent outcomes and typically return patients to activities without complaints.

Whistling deformity often occurs after cleft lip primary repair, marked by deficiency of vermilion tubercle. The purpose of the surgery includes improving the appearance and function of the lip. Adequate amount of vermillion tubercle is necessary to fully cover the front teeth, produce lip seal while speaking consonant sound and balance the projection of face. Many techniques are known to repair whistling deformity from fat injection to Abbe flap. In our department, we use V-Y advancement flap. At certain cases, we repeat the procedure to maximize the result. This simple and less complication technique shows stable outcome during follow up. We recommend this technique because of the non-visible scar after surgery, applicable for unilateral and bilateral cleft lip case at various age, and possible to be done under general or local anesthesia.

Objective: Skin flaps are acceptable methods for surgical treatment of myelomeningocele defects in the neonatal period. Skin flaps (e.g., V-Y advancement, rotation or transposition flaps) are often preferred bilaterally for closure of myelomeningocele defects. This study evaluated the adequacy of an alternative unilateral flap method called “ice cream-cone flap” in repairing large myelomeningocele defects. Patients and Methods: Fifteen newborns who were operated with “ice cream cone flap” due to myelomeningocele defect were evaluated retrospectively. Surgical repair was carried out within 1–3 days of birth. The defect sizes were ranging 10 cm × 8 cm to 4 cm × 4 cm diameter with the mean diameter of 7.2 cm × 5.4 cm. This technique is mainly based on the planning of unilateral advancement flap that resembles the shape of the defect. The technique includes additional procedures such as anchoring of a deepithelialized skin tissue to provide redistribution of the wound closure tension to the lateral side of the flap, and transposition of a skin protrusion to shorten the peripheral border length of the wound. Results: Durable, stable soft-tissue coverage of the defect was obtained in all patients. No hematoma, seroma, infection, and flap necrosis were observed during the postoperative follow-up period. Two patients had partial wound dehiscence which was healed with secondary wound healing. Conclusion: “Ice cream-cone flap” technique is fast, reliable, and easily performed and has the advantage of shorter operative time, less blood loss with minimal wound closure tension.

Episiotomy scar may be the site of complications and result in wound dehiscence in the long term. The aim of this video article was to describe the surgical steps required to repair a right perineal defect after episiotomy using a V-Y advancement flap. Our patient had an episiotomy dehiscence that had already benefited from an end-to-end repair, but the perineal defect recurred. A V-Y advancement flap was performed. The first step of this surgery was to remove the episiotomy scar. A V-shaped flap was then created to fill the perineal defect. Upon advancement, the V flap was transformed in a Y shape and secured using tension-free absorbable sutures. There was no flap necrosis, and the esthetic result was satisfactory.

Chronic anal fissure is difficult to treat. Surgery is usually recommended in the case of drug therapeutic failure. Fecal incontinence in patients with weaker sphincters (multipara older patients with a history of pelvic surgery etc.) is a major reason for rejecting surgery. Such these patients should be underwent fissurectomy and V–Y advancement flap in which sphincterotomy is not required. In this prospective study, we determined the outcomes and complications of fissurectomy and V–Y advancement flap in both groups of patients with low and high anal sphincter tones. Resumo: A fissura anal crônica tem tratamento difícil. A cirurgia geralmente é recomendada em caso de falha do tratamento medicamentoso. A incontinência fecal em pacientes com esfíncteres mais fracos (pacientes multíparas mais velhas com história de cirurgia pélvica etc.) é uma razão importante para a rejeição da cirurgia. Esses pacientes devem ser submetidos a fissurectomia e retalho de avanço em V–Y no qual a esfincterotomia não é necessária. Neste estudo prospectivo, determinamos os desfechos e complicações da fissurectomia e o retalho de avanço em V–Y em ambos os grupos de pacientes com tônus baixo e alto do esfíncter anal. Keywords: Fissurectomy, V–Y advancement flap, Chronic anal fissure, Palavras-chave: Fissurectomia, Retalho de avanço em V–Y, Fissura anal crônica

BACKGROUND According to National Cancer Institute, there are approximately 39,800 rectal cancer cases per year, 25% of which will need an abdominoperineal resection (APR). The key to avoid most of the complications related to pelvic defect that occurs after APR is choosing an appropriate reconstruction option for perineum. This study aims to introduce an easily applicable flap option for closure to address postoperative pelvic defect in low rectal cancer. METHODS This is a retrospective evaluation of 9 patients who have undergone perineal reconstruction for pelvic defects after extralevatory abdominoperineal excision with rectal cancer between 2014 and 2016. Reconstruction consists of a novel technique defined by our clinic, which is buried desepidermised fasciocutaneous V-Y advancement flap. RESULTS All defects are closed successfully. Patients are followed postoperatively for complications such as perineal infection, wound dehiscence, seroma, perineal sinus, or fistula formation. Flaps are evaluated with magnetic resonance imaging postoperatively, for viability and effectiveness on defect closure. Mean follow-up time is 20 (±9) months. Mean average hospital stay is 8 (±2) days. We did not experience any total or partial flap loss or encounter any local complication related to the wound. CONCLUSIONS Buried desepidermised fasciocutaneous V-Y advancement flap is a reasonably easy and time-saving operation. It is effective in filling the pelvic dead space while closing the sacral defect after APR and therefore decreases late term complications related to large perineal excision.

In young patients, even small circular facial defects after the excision of benign skin tumors present a reconstructive challenge. The usefulness of a V-Y advancement flap for reconstructing such defects is well documented. We refined this technique as a mini V-Y advancement flap consisting of two subcutaneous pedicles that vascularize the skin island via subdermal plexus lateral bridges. This technique was used for 21 middle-aged or younger patients with a small benign skin lesion. None of them experienced any postoperative complications. Aesthetically excellent results were found in all patients. This small advancement flap could be attempted as an alternative to fusiform excision of small skin lesions, particularly in younger patients.

Chronic Achilles tendon ruptures are debilitating injuries and are often associated with large tendon gaps that can be challenging for the foot and ankle surgeon to treat. Preoperative evaluation should include the patient's functional goals, medical comorbidities, MRI assessment of gastrocsoleus muscle viability, condition of adjacent flexor tendons, and size of the tendon defect. Although several surgical techniques have been described, the surgeon must formulate an individualized treatment plan for the patient. This article reviews the principles of diagnosis, treatment options, and clinical outcomes, and outlines the authors' preferred techniques.

Vulvoperineal defects after demolitive surgery for preneoplastic or malignant vulvar lesions require a reconstruction to restore good sexual functions and to offer a satisfactory cosmetic result. Several techniques of reconstruction have been described in the past, leading to a more conservative and localized treatment. This study retrospectively reviewed patients with primary or recurrent vulvar malignancies that had undergone vulvoperineal reconstruction between 2010 and 2016 using the V-Y advancement flap and the 2 variant of the lotus petal flap (LPF) in terms of surgical outcome and postoperative complications. Two hundred eighty-four (284) women were reviewed, 234 of them having undergone V-Y flap and 128, the LPF. Overall, postoperative complications occurred in 21.5% of patients including 21% (27/128) of the V-Y group and in 13% (14/106) of the LPF group. The 2 techniques are valid and feasible for vulvar reconstruction in case of moderate defects. No statistically significant differences in terms of complications were observed between the 2 groups overall (P = 0.588), or by comparing the primary (P = 0.202) or the recurrent setting (P = 0.281). Lotus petal flap, particularly the tunneled variant, was superior to V-Y advancement flap in terms of functional and cosmetic results in patients undergoing resection for primary vulvar malignancies.

We report a series of 10 patients who underwent inferolaterally based V-Y advancement flaps for reconstruction of defects involving the lower eyelid and infraorbital cheek junction. Defects ranged from 1.7 to 2.9 cm in largest diameter, and patients ranged from 59 to 84 years of age. All patients had excellent functional and cosmetic outcomes without subsequent surgical or laser revision. There were no instances of flap necrosis, hematoma, or ectropion. Vertically oriented V-Y flaps are often underused in this setting largely due to the perceived increase risk of ectropion. We describe a modification of the flap with lateral orientation that both diminishes the downward tension vector, which threatens ectropion, and conceals incision scars within resting tension lines, providing superior functional and aesthetic outcomes. Our series demonstrates that a properly designed and well-executed inferiorly based V-Y advancement flap can be used as a safe reconstructive modality for defects involving the lid–cheek junction.

Objective: The aim of this study was to compare the surgical outcome of fasciocutaneous V–Y advancement flap and limberg transposition flap used to treat recurrent sacrococcygeal PSD. Methods: A total of 58 patients with recurrent pilonidal sinus who underwent surgery were evaluated retrospectively between January 2008 to December 2013. Fasciocutaneous V–Y advancement flap was performed in 25 patients (Group VYF), and limberg transposition flap repair was performed in 33 patients (Group LTF). Patient demographics, operative and postoperative outcomes were recorded then retrospectively analyzed. Results: The mean age (p = 0.69), sex ratio (p = 0.48), and concomitant diseases (p = 0.98) were not statistically different when compared the VYF with LTF groups. Mean operative time was 55 ± 19 min for the LTF group and 75 ± 25 min for the VYF group (p = 0.01). When length of hospital stay were compared, there was a significant difference between the groups (p = 0.01). Return to work was carryed out after a mean of 23 ± 1.1 days in VYF group and 16.7 ± 1.2 days in LTF group, which is significantly different (p

Background: The aim of this study was to evaluate the efficacy of a combination of flaps for the reconstruction of presacral defects following abdominoperineal resections: a paramedian vertically oriented caudally based lotus petal flap for presacral defects combined with a horizontal V–Y advancement flap for closure of the superficial donor site defect. Methods: A retrospective study was conducted on patients with a residual defect following an abdominoperineal resection between 2010 and 2017 in the Noordwest Ziekenhuisgroep. The primary endpoint was complications related to the reconstruction. Results: Twelve patients were included, all reconstructions healed well. Three patients had a grade I or II complication (Clavien Dindo classification). Conclusions: Use of a petal flap and V–Y advancement flap for reconstruction of presacral defects was found to be safe and simple, and should, therefore, be considered in the management of such problems.

BACKGROUND Anal fissure is an elongated ulcer in the long axis of lower anal canal. The most frequent site for anal fissure is midline posteriorly and followed by midline anteriorly. It causes severe pain during defecation and rectal bleeding that stain the tissue or streaks the stools. Chronic anal fissure has traditionally been treated by surgery, an effective and standard procedure that results in healing in 90-95% of cases. Lateral sphincterotomy heals chronic anal fissure in 90% of cases that is associated with incontinence to flatus and faeces. Anal advancement flaps was used to cover the chronic anal fissure. Using anal flaps to resurface chronic or recurrent anal fissure to promote wound healing and to assess the added advantage over lateral sphincterotomy in tissues of complete epithelialisation; time of relief of pain; persistent symptoms; patient satisfaction and quality of life. The aim of the study is to- 1. Compare the efficacy of lateral sphincterotomy against lateral sphincterotomy with V-Y advancement flap in treatment of chronic anal fissures. 2. Assess the added advantages of V-Y advancement flap in treatment of chronic anal fissure in terms of wound healing, time of relief of pain, persistent symptoms and patients’ satisfaction. 3. Compare the complications associated with procedures. MATERIALS AND METHODS A study of 50 patients was done. It included 26 females and 24 males. In that, lateral sphincterotomy alone was done in 25 patients and lateral sphincterotomy along with anal advancement flap was done in 25 patients. RESULTS In group A patients only lateral sphincterotomy done. In group B lateral sphincterotomy with anal advancement flap done. Anal advancement flap done by ‘v’ shaped flap formed of skin and subcutaneous tissue was elevated incontinuity with excised tissue to allow to cover the tissue defect. Flap should be broad based with adequate blood supply and avoid tension while suturing with 3-0 vicryl. A study of 50 patients was done. It included 26 females and 24 males. In that lateral sphincterotomy alone was done in 25 patients and lateral sphincterotomy along with anal advancement flap was done in 25 patients. CONCLUSION Lateral sphincterotomy with advancement flap gives good postoperative pain relief, earlier healing of fissure and patients are more comfortable in their postoperative period even though the procedure involves considerable dissection and required increased operative time.

Objectives Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. Methods A retrospective review of prospectively collected database was conducted at Virgen de la Arrixaca's Hospital in Murcia (Espana) between January 2000 and December 2013. The study includes all patients who underwent a perineal reconstruction with V-Y flaps. Demographic and surgical data and short-/long-term morbidity was recorded. Results 10 patients were included, 6 males and 4 females. The average age was 58.1 ± 17.4 years. Surgical indication included both malignant and benign pathologies. Operating time was 143.5 ± 41.3 min. R0 resection was performed in all cases although histopathological analysis showed involvement of the deeper margin in 3 cases. Length of hospital stay was 7.8 ± 7.6 days. Regarding complications: 6 patients had partial dehiscence of the flap. None of the patients lost the flap completely. The most frequent late complication was anal stenosis (n=4). Follow up showed total continence in 7 patients. Two patients had variable fecal and/or flatus incontinence. A colostomy was made in one case due to severe incontinence. Conclusions V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique is not free of postoperative morbidity.