Should Every Mummified Toe Be Amputated? Toe Preservation With a Perforator Flap

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Wound Healing

Background:

• Peripheral gangrene presents significant challenges, often necessitating proximal amputation with high mortality risks.
• Common causes include diabetes, peripheral artery disease, trauma, and vasopressor use.
• Traditional amputation methods carry substantial risks of major amputation and patient mortality.

Purpose of the Study:

• To evaluate the efficacy of perforator flaps for toe preservation in patients with peripheral gangrene.
• To assess the viability of using perforator flaps as an alternative to proximal amputation.
• To determine the outcomes of toe preservation techniques in managing peripheral gangrene.

Main Methods:

• Retrospective analysis of six patients with peripheral gangrene affecting nine toes.
• Surgical debridement with minimal bone amputation and coverage using thin perforator flaps.
• Review of patient demographics, surgical details, flap outcomes, and additional procedures.

Main Results:

• High flap survival rate (all but one flap survived).
• Successful infection control and wound healing achieved in most patients.
• Preservation of toe functionality and length was emphasized, with one case requiring a skin graft for partial flap loss.

Conclusions:

• Toe preservation using "encircling" perforator flaps is a viable alternative to proximal amputation for peripheral gangrene.
• This approach may help preserve limb length, but requires careful patient selection and surgical precision.
• Favorable outcomes are achievable with meticulous surgical technique and appropriate patient selection.