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.
Subject(s)
Humans , Amputation, Surgical , Diabetes Mellitus , Diabetic Foot , Fingers , Ischemia , Joints , Methods , Necrosis , Peripheral Vascular Diseases , Surgical Flaps , Toes , Wound Healing , Wounds and InjuriesABSTRACT
Glomus tumors are benign neoplasms that are usually found in the subungual area, and are painful upon palpation. The typical treatment of choice is surgical excision. In rare cases, glomus tumors are observed as large-sized clusters, and are classified as atypical tumors known as glomangiomatosis. While surgical excision is the accepted standard of care, this proves difficult because of the tumors' large size and satellite lesions. We present the successful treatment of asymptomatic glomangiomatosis is situated on the left flank area by a combination of surgical excision and pulsed dye laser, which minimized the risk of scar formation.