Island toe flaps in neurotrophic ulcers of the foot and ankle

Eight plantar island toe flaps for the management of 7 neurotrophic ulcers of the foot and ankle are presented. The plantar vascular anatomy is reviewed with emphasis on functional features and alternate sources of supply. The surgical technique closely parallels that of the Littler neurovascular island flap in the hand. The release of the plantar fascia by incision is the most important technical step in the flap transfer. The procedure is advantageous because it substitutes weight-bearing skin, causes minimal disruption of the plantar anatomy, and is effective even in the presence of small vessel disease.