Post-Traumatic Big Toe Reconstruction using Anterolateral Thigh Free Flap: A Case Report.

Wang, Jae Kwon; Eun, Seok Chan; Baek, Rong Min

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(4):457-460.
Published online July 1, 2010.

Post-Traumatic Big Toe Reconstruction using Anterolateral Thigh Free Flap: A Case Report.

Jae Kwon Wang, Seok Chan Eun, Rong Min Baek

Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Gyeonggi, Korea. sceun@snubh.org

Abstract

PURPOSE
The great toe presents a reconstructive challenge for plastic surgeons. The big toe has much importance not only for the gait and the stability, but also for appearance aspects. Few reports have documented the reconstruction of big toe defects and we report a unique case of free flap reconstruction technique. METHODS: A 41-year-old man with right great toe open fracture with soft tissue necrosis was referred from the orthopedic surgery department. On physical examination, there was the skin necrosis circumferentially and the fratured bone was severely fragmented. The metatarsophalangeal(MTP) joint of the big toe was intact. After the wound debridement, we harvested the innervated anterolateral thigh flap and transposed to the defected area. After five months, we finally retouched the flap by the dorsal defatting and distal debulking.
RESULTS
He had an uneventful postoperative course without infection, dehiscence and flap necrosis. He has remained asymptomatic for eight months without any recurrence such as the osteomyelitis. Finally, he kept the normal gait and posture with weight bearing on the reconstructed great toe and foot.
CONCLUSION
The anterolateral thigh flap is described for the reconstruction of the great toe. It involves two stage procedure with the minimal donor site morbidity and provides a good cosmetic result.

Keywords: Great toe defects; Anterolateral thigh free flap