Closure of elective skin defects in the leg with a fasciocutaneous V–Y island flap

Skin defects in the leg can be among the most difficult to cover. Split skin grafting of such defects can be complicated by delayed healing and poor cosmesis and this has led to the description of several local flap techniques. Here a technique of V–Y flap closure is described based laterally on a random fascial pedicle. Twenty patients aged from 51 to 85 years had flaps for skin closure after excision of skin tumours, 17 of them in the middle or lower third of the leg. All but one were performed under local anaesthetic, seven as day cases and eight with an overnight stay. No patient was excluded because of medical conditions or skin quality and two patients had significant lymphoedema. A single V–Y flap was used in each case and was found to have much greater mobility than previously described similar flaps. Cosmetic results, and in particular contour preservation, were found to be excellent. There were no complete flap losses but four patients had delayed healing, two related to partial flap necrosis. Four patients had wound infections, one requiring readmission for intravenous antibiotics but no patient had further surgery. The fasciocutaneous V to Y island flap was found to be a very satisfactory method of wound closure in the leg with an acceptable complication rate and excellent cosmetic results.