The volar V-Y flap is used in transverse or dorsal oblique amputations in fingertip injuries; however, its use is contraindicated in patients with volar oblique amputations and cannot advance distally enough to cover the defect. The aim of this report is to describe a technique of double V-Y flap to cover fingertip defects in which a simple V-Y flap is not enough. This technique allows advancement between 30% and 50% farther than the original, simple V-Y flap. Report of cases a series of fingertip amputation covered with this technique. This technique was performed in 7 patients between 25 and 64 years old, with transverse, volar and dorsal oblique defects in the fingertip. The advancing of the flap was between 3 and 5 mm. There were no infections or necrosis of the flaps. In all patients there were acceptable aesthetic results with 2-point discrimination between 4 and 6 mm in the proximal flap and up to 10 mm in the distal flap with a minimum follow-up of 6 months. With this double V-Y flap, we have seen a good coverage even in volar oblique amputation. In addition, it is possible to advance up to 5 mm more with this second V-Y flap without compromising the vitality of the flap. It is a simple and reproducible technique that can be used on any finger, with good results, without flap necrosis.
Within scientific teams, a culture of community (the facilitation of shared values, goals, and an environment where individuals feel valued and want to engage in a team’s work) has implications for members’ learning and participation, and the team’s functioning, cohesion, and productivity. Drawing on 12 focus group interviews conducted over four years with 23 participants, we used an autoethnographic approach to examine how a research team developed a positive culture of community that influences its cohesion and productivity. We present six interconnected cultural practices that can foster a culture of community in settings where team-based learning and collaborations are required.
Based on these findings, a flap with reverse flow that the author called a "retrograde ulnar dorsal flap" was designed at the expense of the descending branch by ligating the ulnar dorsal artery where it originates. This makes it possible to cover soft-tissue defects that are more distal on the hand.
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