The V-Y plasty technique is an island pedicle flap procedure. While most local flaps rotate into a wound from nearby tissues, bringing the blood supply with the intact portion of the flap, island pedicle flaps receive the blood supply from below, in the capillaries immediately beneath the dermis. This capillary supply must not be disrupted by undermining the tissue when creating an island pedicle flap.
At first glance, the performance of pedicle flaps may seem daunting, but a simple V-Y plasty pedicle flap easily can be advanced to cover the defect left by fingertip injury. The V-Y plasty advancement flap technique should be used when the injury leaves more pulp than nail bed. Attempts to use this technique when the opposite situation occurs results in undue tension on the flap and failure of the procedure. Physicians must consider their experience level when deciding to perform this procedure. The technique is not difficult to learn but, at centers with readily available hand and plastic surgeons, referral may be considered.