title: Primary closure with a filleted hallux flap after transmetatarsal amputation of the big toe for osteomyelitis in the diabetic foot: a short series of four cases.
abstract: In the diabetic foot, osteomyelitis of the first metatarsal head adjacent to a malum perforans may require resection of the metatarsophalangeal joint. This results in a dysfunctional great toe and large tissue defects that take a long time to heal. The authors postulated that transmetatarsal amputation followed by primary closure with a filleted hallux flap would be feasible in selected cases. Patients that required surgery for diffuse bone destruction of the first metatarsal head were included in the study. Transmetatarsal amputation was performed only if tissue removal rendered the hallux functionless. Primary closure with a filleted hallux flap was attempted in four out of sixteen patients. The developed skin flaps invariably were long enough to cover the plantar tissue defect; no flap necrosis or recurrent infection was noted. Mean healing time was 44 days (range 9-69). Long-term results were disappointing due to ulcer recurrences under the remaining metatarsal heads.
authors.affiliation: Diabetic foot clinic, UZ Brussel, Belgium. dimitri.aerden@gmail.com
authors.forename: Dimitri
authors.initials: D
authors.lastname: Aerden
authors.forename: Bert
authors.initials: B
authors.lastname: Vanmierlo
authors.forename: Nathalie
authors.initials: N
authors.lastname: Denecker
authors.forename: Lutgart
authors.initials: L
authors.lastname: Brasseur
authors.forename: Bart
authors.initials: B
authors.lastname: Keymeulen
authors.forename: Pierre
authors.initials: P
authors.lastname: Van den Brande
mesh_terms: D000671:Amputation, Surgical / Q000379:methods*; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery*; D006214:Hallux / Q000601:surgery*; D006801:Humans; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D012042:Registries; D013524:Surgical Flaps; D013997:Time Factors; D014034:Toes / Q000601:surgery; D014945:Wound Healing