SLR - July 2011 - Evan Cichelli
Reference: Yoshida, A., Yajima, H., Murata, K., Kobata, Y., Shigematsu, K., Kawamura, K., Kisanuki, O., Takakura, Y., Post-Traumatic Big Toe Reconstruction Using Free Flaps, Journal of Reconstructive Microsurgery, 2006; 22: 255-260.
Scientific Literature Review
Reviewed by: Evan Cichelli, DPM
Residency Program: Roxborough Memorial Hospital
Podiatric Relevance:
This study demonstrates the efficacy and patient satisfaction of hallux reconstruction following traumatic injury.
Methods:
Seven male patients were treated for traumatic hallux defects. Ages ranged from 17-59 years, and the etiology of the injuries were as follows: five crush injuries, one amputation from a lawnmower accident, and one degloving injury. There were five incomplete amputations, one complete amputation (lawnmower injury), and one soft tissue necrosis (crush injury). The injury site was reconstructed using free peroneal flaps in five cases, and free scapular flaps in two cases. Peroneal flaps were harvested with a peroneal artery and two veins, scapular flaps were harvested with a circumflex scapular artery and two circumflex scapular veins. In the foot, the artery was anastomosed to the dorsalis pedis artery in six patients and the first dorsal metatarsal artery in one. Bone graft was used in five patients. Iliac crest was used in four as non-vascularized bone, and scapula as vascularized bone in one. The bone graft was fixed to the remaining proximal phalanx using K-wires, and the free flap was placed on top.
Results:
Follow-up ranged between 10-29 months. Flaps completely survived in six patients, with a partial necrosis in one scapular flap secondary to arterial thrombosis. Subsequent debulking procedures were required in some of the peroneal and all of the scapular flaps. Plantar pressure was evaluated and showed significantly higher pressure under the reconstructed toe when compared to the rest of the toes of the same foot; however, this was lower than the pressure of the hallux on the contralateral foot. Callus formation was noted on one patient with a scapular flap, but not on any of the other patients. All patients were able to return to their jobs and were satisfied with the functional and cosmetic outcome of the reconstruction.
Conclusions:
All patients in this study were satisfied with the outcome of the reconstruction. The authors concluded that peroneal flaps are more favorable for these reconstructions because of the equivalent quantity of hypodermis and the need for fewer debulking procedures.