The Webspace Toe Fillet Flap: A Variant Fillet Flap for Wound Closure After Asymmetric Amputation of 2 Adjacent Toes

Abstract

Wound closure after toe amputation for dysvascular necrosis of the toes extending proximally to the metatarsophalangeal joint could be challenging. When necrosis asymmetrically involves 2 adjacent toes, the healthy tissue of the partially necrotic toe could be used as a spare part for surgical wound closure after amputation. This paper reports a variant of the toe fillet flap, the webspace toe fillet flap, which could be performed when facing this clinical situation. After the amputation of the totally necrotic toe at the metatarsophalangeal joint level, the necrotic part of the partially necrotic toe is removed while preserving all the proximal healthy soft tissue, including the neurovascular elements. Therefore, closure is achieved using an axial-pattern digital flap rather than a random flap. In some instances, when necrosis is more distal, the proximal phalanx could be preserved and used as a spacer in the webspace that could possibly avoid lateral clawing of the remaining toes. The webspace toe fillet flap could be an excellent solution for wound closure after asymmetric amputation of 2 adjacent toes. Levels of Evidence: Level V, expert opinion.