Use of a combined pedicled toe fillet flap

Kalbermatten, Daniel F.; Kalbermatten, N. T.; Haug, Martin; Schäfer, Doris; Pierer, Gerhard

doi:10.1080/02844310410027211

Cited by 23 publications

(16 citation statements)

References 6 publications

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“…The TOPHAT lleted toe ap technique in the management of post ray amputation wounds is a simple and reproducible method that does not require complex microsurgical skills or techniques. The vascular supply is consistent based on the digital arteries of the toes, even in patients with diabetes and peripheral vascular disease 13,14 . Hence it is useful in patients where microsurgery may be di cult and reduces the need for more complex soft tissue reconstructive procedures 15,16 .…”

Section: Discussionmentioning

confidence: 95%

A review of the TOPHAT (Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe) filleted toe flap technique for wound coverage during ray amputations

Sim

Lee

Yap

et al. 2020

Preprint

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Background: Wound healing post ray amputation for toe gangrene is commonly complicated by adjacent digital loss after applying Topical Negative Pressure Wound Therapy (TNPWT). This is either due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This ultimately results in exposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) with eventual gangrene and a larger wound bed, thus mandating further ray amputation and subsequently enlarge the wound bed. We describe the use of the TOPHAT filleted toe flap technique – a combination of a filleted toe flap to protect the adjacent MTPJ capsule and a novel Negative Pressure Wound Therapy with instillation and dwell-time (NPWTi-d) dressing technique. The fillet flap protects the adjacent joint capsule and reduce the wound burden whilst allowing the wound to benefit from TNPWT, thereby accelerating wound healing. Methods: We conducted a prospective review of patients with toe gangrene requiring ray amputations who underwent the TOPHAT filleted toe flap technique in our institution from 2019 and 2020. Complications such as wound dehiscence, hematoma, flap necrosis and secondary infection were recorded. Other outcomes recorded were time taken to final skin grafting and time taken for complete wound epithelialisation. Results: 9 patients underwent treatment with the TOPHAT filleted toe flap technique between 2019 and 2020. 2 patients had minimal tip necrosis of the flap which required minor debridement. All except 2 patients whom declined further treatment, progressed to definitive skin coverage with skin grafting. One patient had progressive arterial disease despite successful skin grafting and required above knee amputation. The mean time to final skin grafting was 49.5 days post-operatively and the mean time to final wound epithelialisation was 107.5 days post-operatively. Patients were all satisfied with the outcomes and were able to return to pre-morbid function. Conclusions: The TOPHAT filleted toe flap technique has a consistent vascular supply that provides durable soft tissue coverage. It is a robust and easily reproducible technique to accelerate wound healing after ray amputations even in patients with peripheral vascular disease.

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Section: Discussionmentioning

confidence: 95%

A review of the TOPHAT (Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe) filleted toe flap technique for wound coverage during ray amputations

Sim

Lee

Yap

et al. 2020

Preprint

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“…11 However, metatarsalphalangeal joint of great toe plays an important role in ''toe-off'' phase of gait. Most of the body weight is transferred to the ground during the ''toe-off'' phase and thus faster pace running requires greater range of motion at this joint.…”

Section: Discussionmentioning

confidence: 99%

Modified retrograde‐flow medial plantar island flap for reconstruction of distal dorsal forefoot defects—Two case reports

et al. 2010

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Soft tissue reconstruction of the distal forefoot and toes poses a difficult problem. Skin grafts are not suitable when deep structures are exposed. Local flaps are not available, particularly for defects of the toes. Free flaps are spared for larger defects. Medial plantar flap has been widely used for plantar defects, especially weight-bearing surface of the heel. Distally based retrograde-flow design of this flap allows the transfer of the pedicled flap distally and provides coverage of soft tissue over the metatarsal heads. In this report, we further modified the retrograde-flow medial plantar island flap to extend its use for distal dorsal forefoot defects. The technique and outcomes of two patients are presented.

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“…Fillet flaps are axially patterned flaps harvested from adjacent non-functioning soft tissue structures. They can be used as pedicled or microvascular free flaps for reconstruction and are a compelling method of reconstruction if enough tissue is available around the defect [ 8 ]. Since Alpert and Buncke [ 9 ] first introduced the concept of fillet flaps for the coverage of mutilating hand injuries in 1978, they have been widely used as a tool for the reconstruction of distal limbs.…”

Section: Discussionmentioning

confidence: 99%

Modified toe pulp fillet flap coverage: Better wound healing and satisfactory length preservation

2018

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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.

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Use of a combined pedicled toe fillet flap

Cited by 23 publications

References 6 publications

A review of the TOPHAT (Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe) filleted toe flap technique for wound coverage during ray amputations

A review of the TOPHAT (Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe) filleted toe flap technique for wound coverage during ray amputations

Modified retrograde‐flow medial plantar island flap for reconstruction of distal dorsal forefoot defects—Two case reports

Modified toe pulp fillet flap coverage: Better wound healing and satisfactory length preservation

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