Fillet of Toe Flap Coverage for Non-Traumatic Foot Amputations: A Retrospective Review of 70 Patients

Fillet of toe flap (FTF) leverages the "spare parts" algorithm in reconstructive surgery-utilizing tissue from amputated or otherwise non-salvageable body parts, thus avoiding donor-site morbidity. This study assesses the efficacy of FTF coverage in non-traumatic foot amputations. A retrospective review of patients undergoing foot amputation with FTF coverage between January 2013 to August 2023 was conducted. Patient characteristics, operative details, and outcomes were collected. Primary outcome was FTF survival (no necrosis ≤7 days postoperatively). Secondary outcome was acute complications (≤42 days postoperatively). A total of 70 patients were included. Mean age was 65.0±13.7 years. Median Charlson Comorbidity Index was 6.0 (interquartile range [IQR]: 4.0-7.0). The most common wound location was the hallux (n=34). In 45 (64.2%) patients with preoperative angiography, the patency rates were: first dorsal metatarsal artery (n=10, 22.2%), lateral plantar artery (n=7, 15.6%), medial plantar artery (n=6, 13.3%), and dorsalis pedis artery (n=4, 8.9%). Mean follow-up duration was 9.0 (IQR: 32) months. Fifteen (21.4%) patients experienced at least one acute complication: deep surgical site infection (SSI; i.e., abscess, gangrenous necrosis; n=13, 18.6%) and cellulitis (n=7, 10.0%). Eleven (15.7%) patients required reoperation for debridement (n=4, 5.7%), wound closure (n=4, 5.7%), flap necrosis (n=3, 4.3%), incision and drainage (n=1, 1.4%), split-thickness skin grafting (n=1, 1.4%), and foreign body exploration (n=1, 1.4%). FTF survival was 94.2% (n=66). FTF facilitates reconstruction in complex cases and should be integrated into each chronic LE wound algorithm to avoid additional donor-site morbidity, and to facilitate stump-length preservation or limb salvage.