Baek Sang Oon, Suh Hyo Wan, Lee Jun Yong
Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Arch Plast Surg. 2018 Jan;45(1):62-68. doi: 10.5999/aps.2017.01501. Epub 2017 Oct 27.
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.
截肢术常用于治疗由外周血管疾病（如糖尿病）继发的足趾坏死。在对坏死足趾进行截肢时，保留骨结构对于防止相邻趾头塌陷至截肢空间至关重要。然而，在常用的Syme's终末截肢技术中，远节趾骨的部分截肢可能会导致伤口边缘张力增加。在此，我们基于对足趾的形态学分析，介绍一种在保持正常长度的同时切除足够骨结构的新方法。
与远节趾骨的手指指腹不同，足趾有丰富的泪滴状指腹组织。比较了足趾和手指远节趾骨的垂直长度与纵向长度之比。在近端指间关节水平进行截肢。然后，将可移动的指腹皮瓣向头侧旋转90°以替代远端软组织缺损。对5例患者实施了这种改良的足趾鱼际皮瓣手术。
与手指相比，发现足趾指腹具有垂直方向的形态，通过向头侧旋转能够保留长度。所有缺损均成功覆盖，且无边缘缺血。
传统的足趾鱼际皮瓣覆盖术将长度保留原则作为首要重点，而我们的改良方法兼顾了伤口愈合和长度。指腹最肥厚的部分推进至足趾尖端，起到缓冲作用，并提供足够长度以替代趾骨缺失。我们的改良方法带来了满意的功能和美学效果。
