[Reverse flow YV pedicle extension: a method of doubling the arc of rotation of a flap under certain conditions].

The authors present a new surgical procedure which allows the transfer of pedicled flaps distally to the origin of their vascular pedicle. They call this procedure the "reverse-flow YV pedicle extension of a flap". The idea is to raise a flap distally on a branch of a Y-like vascular bifurcation. The section of the trunk of the bifurcation turns the Y-into a V-vascular pattern, which allows distal mobilisation of the flap on the remaining branch of the V. The distal range of transposition of the flap can reach twice the length of one bifurcation of the flap. The arterial blood supply is provided by reverse-flow through the attached remaining branch of the V. Venous drainage is ensured as in a distally based pedicled flap. Up until now, the authors have performed six different applications of this procedure: arterial lengthening of a latissimus dorsi flap pedicled on the circumflex scapular artery for coverage of the vertex (a venous anastomosis is required in this case; lengthening of the submental vein in very distal transfers of a submental flap; lengthening of an arteriovenous pedicle: transfer of the anterior interosseous flap which can reach the PIP joint of long digits, transfer of an amputated digit on to the adjacent stump, distal transfer of a medial plantar flap allowing it to reach the tip of the toes, transfer of the lateral arm flap on to the triceps branch of the profunda brachii artery. This flap can reach the metacarpal area of the hand. This procedure seems to very usefully replace microsurgical techniques in many circumstances in which, until now, they would have been necessary. Further applications will be discussed.