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Modified toe pulp fillet flap coverage: Better wound healing and satisfactory length preservation
Sang Oon Baek1, Hyo Wan Suh1, Jun Yong Lee1
1Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Archives of Plastic Surgery
|October 28, 2017
Summary
A modified toe amputation technique preserves toe length and improves wound healing. This method uses a unique pulp flap rotation to cover defects after bone resection, ensuring better functional and aesthetic outcomes for patients with peripheral vascular disease.
Area of Science:
- Plastic Surgery
- Orthopedic Surgery
- Vascular Surgery
Background:
- Toe amputation is common for necrosis from peripheral vascular diseases like diabetes mellitus.
- Preserving bony structure post-amputation prevents adjacent digit collapse.
- Conventional Syme's amputation can increase wound tension due to distal phalanx removal.
Purpose of the Study:
- To introduce a novel toe amputation technique for resecting bone while maintaining length.
- To address limitations of existing amputation methods regarding wound healing and length preservation.
- To utilize morphological analysis of toes for surgical innovation.
Main Methods:
- Compared vertical to longitudinal length ratios of distal phalanges in toes versus fingers.
- Performed amputation at the proximal interphalangeal joint.
- Created a mobilizable pulp flap rotated 90° cephalad to cover soft tissue defects.
- Applied this modified toe fillet flap in 5 patients.
Main Results:
- Toe pulp exhibits a vertically oriented morphology, facilitating length preservation via cephalad rotation.
- Successful defect coverage was achieved in all cases.
- No instances of marginal ischemia were observed post-surgery.
Conclusions:
- The modified method balances wound healing and length preservation, unlike conventional techniques prioritizing length alone.
- Advancing the fattiest pulp portion to the toe tip provides cushioning and substitutes for phalangeal bone loss.
- Satisfactory functional and aesthetic results were achieved with this modified approach.
