V-Y PLASTY TECHNIQUE FOR RECONSTRUCTION OF SKIN DEFECTS (2024)

V-Y PLASTY TECHNIQUEFOR RECONSTRUCTION OF SKINDEFECTS

*MehmetBekerecioğlu, MD
**Mustafa Tercan,MD
*** Önder Tan, MD
****Bekir Atik, MD

SUMMARY

V-Yplasty is areliable technique used incovering defects andwounds or inlengthening some anatomicstructures. In this studywe presented the resultsof 81 patients whounderwent V-Y plastyoperations in differentparts of the body. Weused this techniquefor 38 patients in headand neck region,23 patients withpilonidal sinus, 8 patients having sacral pressure sores,7 patients withplantar wounds and 5patients having finger tipdefects. V-Y plasty has beenused everywhere on the body, but less soin plantar region.We conclude thatV-Y plastyis a reliable technique andcan be used forthe plantarregion as wellas the other surface areas ofthe body.

Key words: V-Yplasty, Head andneck, Plantar region, Pressure sores, Skin tumors, Skindefects

INTRODUCTION

V-Yplasty technique iscommon in plastic surgical practice.This technique isprobably described byBlasius (McCarthy JG, 1990). Inthis technique, an incisionis made as Vpattern and the V patterned skinis approached tocover the defectedarea as Y shape (Fig.1). Most authorsoffered the technique as areliable method forreconstruction of relativelysmall defects (Parry S et al,1989; Khatri VP et al, 1994).There are agreat deal of methodto cover defectsin plastic surgery. The V-Y plasty amongthese techniques isthe one ofthe most reliablemethod (Nilson RZ et al, 1995). Although V-Y plasty is acommon procedure to cover thedefect it haslimited usage in coveringof lower extremitydefect. Various flaps havebeen used tocover the plantar defect of the foot. Flapshave been usedto cover the defects in weigh bearing areas. Thecovering of thedefects in diabeticfoot must be reliable and let the woundheal without complication. In thisstudy, V-Y flaps using inweigh bearing areaswas emphasized.

METHODSAND MATERIALS

Eighty-one patients wereinvolved in thisstudy. Mean age ofthe patients was34.3 (6-72) and male/femaleratio was 2.7/1 (59/22). The unilateral orbilateral using V-Y plasty wasdepend on the diameter of the defect. Fasciacutane V-Y plasty wasused to cover thepressure sores and pilonidal sinus. Prophylactic antibiotics were given for head andneck region butseven days for trunk andlower extremity. Vacuumeddrain was placed to the trunk defects. Of seven plantar defectof patient fourwere diabetics.

RESULTS

The V-Y plasty wasused in eighty-one patients (Table 1). Location of the defectsin the body are representedin figure2.

Head andneck region arethe most suitableregion for V-Y plasty. There wasnot seen any complication onthis region. Location of theV-Y plasties onthe head andneck region aredemonstrated in table 2. The defects consist of skin cancers, traumatic defects, whistling deformity and variousskin lesions (Table3). Of 25patients, 17 patients arebasal cell carcinoma (BCC) and 8squamous cell carcinoma (SCC). 8 patients with traumatic defect (scalp,forehead and eyelid) and 2 patients with whistling deformity of the vermilionwere used this procedure.

Of five patients with finger tip defect, one bilateraland four unilateralV-Y plasties wereperformed.

Seven pilonidal sinuses and six pressure sores were treated by usingbilateral fasciacutaneousV-Y plasty in the sacralregion. Minimal wounddetachment and seromawere seen inthe three pilonidalsinus patients and onepressure sore atthe postoperative period. Thirty-one patients (pilonidal sinus 23 and sacral pressure sore 8) weretreated in the sacral region totally.

Seven V-Y plastieswere done onthe plantar region. Ofseven patients, fourpatients were diabetics. Minimal wound detachment andinfection were determinedin two patients at thepostoperative period.

Discussion

V-Yplasty is oneof the methods to coverdefects and elongationof some anatomicstructure (Zook EG et al, 1980). V-Yplasty has onesession operation,

shortoperation time anda reliable method. V-Yplasty was used for revision of perioral scar (YangJY, 1996), columella elongation (ShinKS et al, 1994), treatment of eyeliddefects (Okada E et al, 1997), reconstruction of the orbital region (Johnson CC, 1978), scalp defects (Crabetta I et al, 1994),whistling deformity ofvermilion (Kapetansky KI, 1971). V-Yplasty was mostly used forhead and neck regionin our cases (% 46.9). There wasno complication in this region. Of38 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 deformityof vermilion (%7.9), 2 have defect inthe forehead region (% 5.3) and 2have scalp defect (%5.3). Histopathologic examinations of 28 patients, 17patients were BCC (% 56.7),8 patients were SCC (26.7), 2 patientswere nevus sebaceous (% 6.6) and 1 patient was intradermal nevus (% 3.4).Follow up of the tumors ofhead and neckregion is the mean16.8 months (between 11-27 months). The role of V-Yplasty in thetreatment of pilonidalsinus has beenpresented (Dilek ON et al, 1998). Khatri et al were reported goodresults of treatment of recurrent pilonidal sinuswith V-Y plasty (Khatri VP et al,1994). The bilateral fasciacutaneousV-Y plasties wereperformed in 23patients (% 28.4) for pilonidalsinus treatment. Minimal complications were seen suchas infection and seromain 3 patients. No recurrentwas seen and goodresults were achievedin these patients. Fasciacutaneous V-Y plastyhas been performedwith good resultsfor sacral andgluteal (Wechselberger G et al, 1997; Lee HB et al, 1997). V-Y plastyis also performedfor Dupuytren contracture in upperextremity (Mahaffey PJ, 1996). Oneof the treatment method offingertip defect isV-Y plasty (Frandsen PA, 1978;Atasoy E et al, 1970; Shepard GH, 1983). Fivepatients with fingertipdefects operated for fingertipdefect (% 6.2). V-Y plasty is used forperianal reconstruction (Sagher U et al, 1992). Reconstruction of lowerextremity defects,especially weight bearingareas, needs specialattention (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 plastyin the plantar regionis rare (Colen LB et al, 1988).Diabetic patients especiallyhas limitation whenthe wound locatedon the weight bearing area. Of sevenpatients, four were diabetics. Wound infectiondeveloped in twopatients. There were no complications seen in remainingpatients whohad operations in the plantarregion.

Finally, V-Y plasty is areliable method thatcan be usedalmost everywhereon the body surfaceand also seems asreliable forthe plantar region.

REFERENCES

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Table1. Locationsof V-Y plasty.

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

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

Figure1: Schematic diagram ofV-Y plasty procedure.

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