Modified toe pulp fillet flap coverage: Better wound healing and satisfactory length preservation
Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the...
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Published in | Archives of plastic surgery Vol. 45; no. 1; pp. 62 - 68 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
Thieme Medical Publishers, Inc
01.01.2018
Korean Society of Plastic and Reconstructive Surgeons 대한성형외과학회 |
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Abstract | Background
Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme’s amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes.
Methods
Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated 90° cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients.
Results
The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia.
Conclusions
While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes. |
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AbstractList | Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes.
Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated 90° cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients.
The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia.
While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes. Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme’s amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardropshaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated 90° cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes. KCI Citation Count: 0 BACKGROUNDAmputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. METHODSUnlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated 90° cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. RESULTSThe toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. CONCLUSIONSWhile conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes. Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme’s amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated 90° cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes. Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme’s amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme’s amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated 90° cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes. |
Author | Suh, Hyo Wan Baek, Sang Oon Lee, Jun Yong |
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Cites_doi | 10.1016/S0039-6109(16)33299-6 10.3113/FAI.2012.0707 10.1080/02844310410027211 10.1177/1938640014560163 10.1302/0301-620X.60B1.627572 10.1097/00006534-200109150-00011 10.1097/00007611-198909000-00019 10.1016/S0363-5023(78)80074-4 |
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References_xml | – volume: 31 start-page: 575 year: 1950 ident: ref10 article-title: The terminal syme operation for ingrown toenail publication-title: Surg Clin North Am doi: 10.1016/S0039-6109(16)33299-6 contributor: fullname: TC Thompson – volume: 33 start-page: 707 year: 2012 ident: ref4 article-title: Partial foot amputation in patients with diabetic foot ulcers publication-title: Foot Ankle Int doi: 10.3113/FAI.2012.0707 contributor: fullname: ML Brown – volume: 38 start-page: 301 year: 2004 ident: ref8 article-title: Use of a combined pedicled toe fillet flap publication-title: Scand J Plast Reconstr Surg Hand Surg doi: 10.1080/02844310410027211 contributor: fullname: DF Kalbermatten – volume: 8 start-page: 273 year: 2014 ident: ref5 article-title: Digital fillet flaps a systematic review publication-title: Foot Ankle Spec doi: 10.1177/1938640014560163 contributor: fullname: VL Schade – volume: 60 start-page: 126 year: 1978 ident: ref3 article-title: Partial amputation of the foot for diabetic or arteriosclerotic gangrene: results and factors of prognostic value publication-title: J Bone Joint Surg Br doi: 10.1302/0301-620X.60B1.627572 contributor: fullname: U Larsson – volume: 108 start-page: 885 year: 2001 ident: ref6 article-title: The concept of fillet flaps: classification, indications, and analysis of their clinical value publication-title: Plast Reconstr Surg doi: 10.1097/00006534-200109150-00011 contributor: fullname: MV Kuntscher – volume: 82 start-page: 1138 year: 1989 ident: ref2 article-title: Amputation of the distal portion of the foot publication-title: South Med J doi: 10.1097/00007611-198909000-00019 contributor: fullname: MJ Hodge – start-page: 62 issue: 122 year: 1977 ident: ref7 article-title: Amputations of the foot and ankle: current status publication-title: Clin Orthop Relat Res contributor: fullname: FW Wagner Jr – volume: 3 start-page: 196 year: 1978 ident: ref9 article-title: Multilating multidigital injuries: use of a free microvascular flap from a nonreplantable part publication-title: J Hand Surg Am doi: 10.1016/S0363-5023(78)80074-4 contributor: fullname: BS Alpert – volume: 7 start-page: 6 year: 1964 ident: ref1 article-title: Partial amputations of the foot: a follow-up study publication-title: Can J Surg contributor: fullname: WR Harris – volume: 20 start-page: 95 year: 1981 ident: ref11 article-title: The terminal Syme procedure publication-title: J Foot Surg contributor: fullname: BW Gastwirth |
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Snippet | Background
Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic... Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe,... Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic... BACKGROUNDAmputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic... |
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SubjectTerms | Amputation Diabetic foot Original Original Article Surgical flaps Wound healing 성형외과학 |
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Title | Modified toe pulp fillet flap coverage: Better wound healing and satisfactory length preservation |
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ispartofPNX | Archives of Plastic Surgery, 2018, 45(1), , pp.62-68 |
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