V-Y Advancement Flap Coverage of Toe-Tip Injuries

Toe-tip injury presents a challenging problem. There are few techniques that provide cover for distal toe defects, and most injuries are usually treated with terminalization or a skin graft. In patients with toe-tip injuries where there is preservation of the plantar toe pulp, V-Y flap advancement is a therapeutic option. In this article, we describe the surgical technique used and present the results of 10 patients with dorsal oblique or transverse toe injuries that underwent V-Y flap advancement for defect coverage. Eight patients had distal great toe injuries, 1 had a dorsal oblique amputation of the third toe, and 1 had a transverse amputation at the metatarsophalangeal joint level. Mean follow-up was 5 months, at which time all patients had returned to their previous activity level, and showed acceptable levels of scarring. The V-Y advancement flap, commonly used in fingertip injuries, when indicated and carefully performed gives excellent contour and padding, maintains toe length, and provides good cosmesis for treatment of toe amputations. Level of Clinical Evidence: 4.