Toe Fillet Flap Wound Coverage for a Multiple-ray Amputation Wound: A Case Report.

Area of Science:

• Podiatric Surgery
• Vascular Surgery
• Wound Healing

Background:

• Diabetic foot gangrene often necessitates ray amputation, leaving large wounds that heal slowly by secondary intention.
• These wounds pose risks of infection and complications due to prolonged healing times.
• Peripheral vascular disease exacerbates healing challenges in diabetic patients.

Observation:

• A 77-year-old male with diabetes and peripheral vascular disease presented with gangrene of the left 2nd-5th toes.
• Following successful lower limb angioplasty, a left 2nd-5th toe ray amputation was performed.
• Excess viable skin from the second toe was utilized as a digital fillet flap for wound coverage.

Findings:

• The digital fillet flap provided effective coverage for the ray amputation wound.
• Despite a minor complication (stitch sinus), the wound achieved complete healing with good epithelialization within 4 months.
• The patient was discharged on postoperative day 1, indicating efficient initial recovery.

Implications:

• The toe fillet flap is a useful technique for managing ray amputation wounds in diabetic patients with peripheral vascular disease.
• This flap method can potentially reduce healing time and complications associated with secondary intention healing.
• It highlights an innovative approach to limb salvage and wound management in complex diabetic foot cases.