Importance of Toe Flaps Procedure

Toe Flaps are a very versatile procedure that can come in handy when dealing with gangrene or wounds of the foot that require amputation. The idea is simple: if the toe has good flow, has good skin coverage and is free of infection, it can be used to cover defects. Diabetic wound care is one of the many conditions that require constant care The biggest drawback is that you have to sacrifice a toe but often the patient population that requires an amputation, such as our diabetic patient population, have low physical demands.

This is a case of a diabetic male patient who was admitted to the hospital with gangrene and osteomyelitis of the 1st metatarsal and the big toe. The skin on the big toe was healthy. Imaging studies confirmed the diagnosis. Patient also underwent vascular intervention to restore blood flow.

Decision was made for surgery to excise necrotic and infected bone but it would have left a significant wound on the foot which would require months of therapy with negative pressure wound vac and regular debridements. In this case we excised all necrotic and infected bone including all the bones of the big toe but saved the skin and soft tissue of the toe itself. This was then used as a flap to close the skin and soft tissue deficit which was created to remove the infection and gangrenous tissue.

This technique can be used with all toes. Minimal weight bearing is advised after surgery until the flap adheres completely.