- The V-Y flap closure is used to close high-tension wounds in areas where undermining the skin alone will not close the wound. It should be reserved for less cosmetically sensitive areas.
- The V-Y flap closure is satisfactory for areas with excellent subcutaneous blood supply.
- Diabetes (relative)
- Impaired wound healing
- Vascular compromise to region
- Keloid or hypertrophic scar formation
- Previous radiation to region
- Coagulopathy (intrinsic or induced through anticoagulants such as warfarin)
- Wound location on lower extremity, especially the feet (due to slow healing) (relative)
- Topical antiseptic wash: Povidone-iodine or chlorhexidine gluconate
- 5-mL syringe with needles (16- to 20-gauge to draw up anesthetic, and 27- to 30-gauge for tissue injection)
- Injectable local anesthetic: 1% to 2% lidocaine with epinephrine for most areas. If flap viability is going to be a concern, it is best to limit or eliminate the use of epinephrine.
- Sterile drape
- Sterile gloves
- Sterile gauze pads
- Telfa pad (Covidien Ltd., Mansfield, MA) and Tegaderm (3M, St. Paul, MN)
- Skin marking pen
- Nylon suture (4-0, 5-0, or 6-0, depending on location)
- 4-0, 5-0, or 6-0 absorbable suture such as Vicryl or Dexon, if deep sutures are indicated
- Adson forceps
- Needle holder (smooth)
- No. 15 scalpel
- Suture scissors
- Two skin hooks
- Scissors, Metzenbaum, curved, 5 to 5½ inches
- Hemostats, curved, mosquito, 2 inches
- Hemostats, straight, small, 2 inches
- Good lighting
- The skin is composed of three layers—epidermis, dermis, and subcutaneous tissue.
- The epidermis, the outermost layer of skin, is composed of epithelial tissue.
- The dermis is the layer below the epidermis; it not only supports the skin, but it contains sweat glands, erector muscles, hair follicles, nerves, and blood vessels.
- The subcutaneous tissue is below the dermis and consists of adipose tissue and larger blood vessels and nerves.