Thumb tip reconstruction for apical substance loss using a bipedunculated homodigital V-Y advancement FLAP: OUR experiences

Introduction: The thumb plays a crucial role in hand biomechanics, particularly in fine and forceful grips. Due to its functional importance, trauma involving the thumb is frequent. In cases of pulp tissue loss, Moberg's 1964 principles for functional thumb reconstruction remain a cornerstone in hand surgery. Among the available techniques, the bipedunculated V-Y advancement flap, described by D. Elliot in 1993, offers a reliable solution for preserving length, restoring sensation, ensuring grip stability, and maintaining an aesthetically acceptable outcome. Materials and Methods: We retrospectively analyzed 54 cases of thumb tip reconstruction using the bipedunculated V-Y advancement flap for apical substance loss ranging from 1.0 to 2.5 cm in length. Patients had a mean follow-up of two and five years. Functional and aesthetic outcomes were assessed using the Pinch Test, Weber and Semmens Test, Vancouver Scar Scale, QuickDASH questionnaire and Fingertip Injury Outcome Score. Results: Our statistical analysis confirms the reliability and versatility of this flap. No major or minor complications were recorded. The flap effectively addressed transverse and oblique defects up to 1.5 cm, providing excellent functional and cosmetic results. Conclusions: This study validates the bipedunculated V-Y advancement flap as an effective technique for thumb tip reconstruction, emphasizing the importance of adhering to fundamental principles of digital reconstruction. The procedure ensures excellent functional outcomes and high patient satisfaction.