Atasoy et al. describe the triangular volar flap (V-Y advancement) for fingertip reconstruction when the distal phalanx is exposed. A distally based volar flap is advanced over bone and the V incision is closed as a Y, preserving the neurovascular pedicle. The paper reports technique, indications, and outcomes in 61 patients with 64 amputations treated at the University of Louisville.
When you see a fingertip amputation with exposed distal phalanx, your first question is amputation pattern: transverse or dorsal oblique means the Atasoy flap is on the table; volar oblique with significant soft-tissue loss means you need another approach.
The key advantage Atasoy demonstrated over prior methods, including the Kutler bilateral flap, was consistent sensory preservation. Because the neurovascular pedicle stays intact within the advancing flap, the reconstructed tip retains normal protective and discriminative sensation — not a skin graft, not a flap from a distance.
Practically, this also means no limb immobilization and no staged procedures. The patient leaves with a finger dressing, not a cross-finger flap holding two digits together for weeks. Know the geometry: the base of the triangle must be at least as wide as the nail matrix edge, and the apex sits at the distal flexion crease. The V closes as a Y. That is the entire operation.
Atasoy et al. describe the triangular volar flap (V-Y advancement) for fingertip reconstruction when the distal phalanx is exposed. A distally based volar flap is advanced over bone and the V incision is closed as a Y, preserving the neurovascular pedicle. The paper reports technique, indications, and outcomes in 61 patients with 64 amputations treated at the University of Louisville.
When you see a fingertip amputation with exposed distal phalanx, your first question is amputation pattern: transverse or dorsal oblique means the Atasoy flap is on the table; volar oblique with significant soft-tissue loss means you need another approach.
The key advantage Atasoy demonstrated over prior methods, including the Kutler bilateral flap, was consistent sensory preservation. Because the neurovascular pedicle stays intact within the advancing flap, the reconstructed tip retains normal protective and discriminative sensation — not a skin graft, not a flap from a distance.
Practically, this also means no limb immobilization and no staged procedures. The patient leaves with a finger dressing, not a cross-finger flap holding two digits together for weeks. Know the geometry: the base of the triangle must be at least as wide as the nail matrix edge, and the apex sits at the distal flexion crease. The V closes as a Y. That is the entire operation.