Distal fingertip amputation suitable for a V-Y advancement flap. A, Ample pulp skin with outline of intended skin incision. B and C, Flap raised with sequential dissection from the distal phalangeal periosteum and flexor digitorum profundus tendon centrodorsally, and dorsoradial and dorsoulnar margins by dissection down to the distal phalangeal bone laterally, and septal release volarly. Note that the neurovascular bundles must be carefully kept with the pulp skin, and direct inspection of them is not always possible. D, Flap sutured into position with proximal open area left open to heal by secondary intention. E, Clinical result at 6 weeks postoperatively. SEE TECHNIQUE 19.1.