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Modified Fillet Toe Flap for Toe Amputation: A Random-pattern Approach beyond the Axial Concept.

Misa Hasegawa¹, Hina Fujii¹, Ryo Okusako²

¹From the Department of Plastic and Reconstructive Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.

Plastic and Reconstructive Surgery. Global Open

|June 29, 2026

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A modified fillet toe flap technique enhances reconstruction for ischemic limbs by preserving vascular networks. This approach offers a practical solution for forefoot defects, improving patient outcomes.

Area of Science:

Plastic Surgery
Vascular Surgery
Reconstructive Surgery

Background:

The fillet toe flap uses nonsalvageable toe tissue for reconstruction, adhering to the 'spare parts' concept.
Its application in ischemic limbs is historically limited due to compromised arterial inflow.
Emerging research highlights the role of collateral and subdermal vascular networks in maintaining perfusion under ischemia.

Purpose of the Study:

To present a modified fillet toe flap technique for reconstructing forefoot defects in patients with ischemic or neuropathic conditions.
To evaluate the safety and efficacy of this modified flap in a clinical setting.

Main Methods:

A modified fillet toe flap was developed, incorporating a limited plantar releasing incision to enhance mobility while preserving the dorsal subdermal vascular plexus.

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The flap was conceptualized as a random-pattern pedicled flap.

Five patients with toe amputation defects (one diabetic neuropathic ulcer, four chronic limb-threatening ischemia) underwent reconstruction after revascularization and confirmed local perfusion improvement.

Main Results:

The modified flap facilitated three-dimensional unfolding and coverage of challenging defects.
No total flap necrosis was observed.
Minor complications included partial wound dehiscence and mild distal perfusion disturbance; no reamputations were required.

Conclusions:

The modified fillet toe flap reinterprets the traditional axial concept as a random-pattern technique, expanding its applicability.
This technique offers a practical reconstructive option for ischemic or neuropathic forefoot defects in carefully selected patients post-revascularization.
Stable wound coverage was maintained during a mean follow-up of 23 months in surviving patients.