• Journal of Korean Foot and Ankle Society
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• v.21 no.4
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• pp.135-138
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• 2017

Purpose: The purpose of this study is to determine the correlation between the correction loss of hallux valgus angle and the severity of valgus angle of the second toe. Materials and Methods: We selected 312 cases from 268 surgical patients with hallux valgus deformity receiving distal chevron osteotomy. For a radiological evaluation, we analyzed the changes in the hallux valgus angles, first to second intermetatarsal angles, and valgus angle of the second toe post index operations. All patients were women; the mean age was 46 years. The mean follow-up period was 17 months. Results: The mean hallux valgus angle was $33.6^{\circ}$ preoperatively (range, $25.7^{\circ}{\sim}44.8^{\circ}$), $13.1^{\circ}$ (range, $8.4^{\circ}{\sim}16.4^{\circ}$) after 4 weeks of postoperative period, and $17.1^{\circ}$ (range, $9.4^{\circ}{\sim}28.5^{\circ}$) at their final follow-up. The mean valgus angle of the second toe was $8.4^{\circ}$ preoperatively (range, $2.0^{\circ}{\sim}25.8^{\circ}$) and $8.3^{\circ}$ (range, $1.7^{\circ}{\sim}24.9^{\circ}$) at the final follow-up. Preoperatively, there was a positive correlation between the valgus angle of the second toe and hallux valgus angle (r=0.747, p=0.001). The correction loss of hallux valgus angle had a significant correlation with the severity of valgus angle of the second toe (r=0.802, p=0.001). Conclusion: The existence of the second toe valgus deformity may present itself as a cause of correction loss of hallux valgus angle. The preoperative measurement of the second toe valgus angle may be a good predictor of correction loss; therefore, thorough preoperative warning on the possibility of correction loss should be conducted to maximize patient satisfaction after the procedure.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.19-28
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• 2002

From 1994-2001, 25 mutilated digits were reconstructed with immediate toe-to-hand transfer in acute hand injury in 21 patients. There were 15 cases of great toe-to-hand transfer(partial great toe transfer 8 cases, modified wrap-around procedure 2 cases, and trimmed great toe transfer 2 cases) for thumb reconstruction, 2 cases of second toe transfer for index reconstruction, and 4 cases of simultaneous two toe-to-hand transfer(great toe & second toe transfer 1 case, bilateral second-toe transfer 2 cases, combined second & third toe transfer 1 case) for reconstruction of multiple digit amputations. Two cases of emergency exploration(2/25, 8%) were successfully salvaged. The incidence of emergency exploration and postoperative infection was not significantly different from that of the elective toe-to-hand transfer cases. Duration of industrial insurance coverage was 225 days, which is much shorter than that of elective cases. Among 43% of patients maintained their original job even after injury and immediate toe-to-hand transfer. The subjective satisfaction self- assessment scores of aesthetic appearance and function on the new reconstructed thumb were 80 and 88 in average, respectively, over a total score of 100. These were higher than those of reconstruction of other digits, but lower than those of elective reconstruction. The donor site after harvest of the great toe was mostly unsatisfied in a view of appearance. Immediate toe-to-hand transfer provides many advantages over elective procedure in acute hand injuries such as single stage reconstruction, shortened convalescent period, early return to work and efficient socio-economic factor. Furthermore because there were no significant differences in success rate, frequency of complications or ultimate functional result, immediate toe-to-hand transfer is a safe and reliable procedure in case of limited indications for acute digits loss.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.508-511
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• 2011

Purpose: Blue toe syndrome consists of blue or purplish toes in the absence of a history of obvious trauma, serious cold exposure, or disorders producing generalized cyanosis. It is a life-threatening and still underrecognized disease. It can be commonly occurred by vascular surgery, invasive cutaneous procedures or anticoagulant therapy. Our case is presented of blue toe syndrome related to atheromatous embolization that was presumably triggered by angio CT. Methods: A 69-year-old man presented with the suddenly developed pain, cyanosis and livedo reticularis of the toes in right foot. Dorsalis pedis pulses were palpable. He had been performed a diagnostic angio CT 1 month earlier. Angio CT revealed diffuse aortic atheromatous plaque in lower abdominal aorta and both common iliac artery. One month after angio CT, he visited our clinic. There was no visible distal first dorsal metatarsal artery and digital artery of right first toe in lower extremity arteriography. A diagnosis was established of blue toe syndrome. Because his symptom was aggravated, we performed the exploration of the right foot. After exposure of first dorsal metatarsal artery, microsurgical atheroembolectomy was done. Results: There were no postoperative complications. After three months the patient had no clinically demonstrable problems. Conclusion: Patient with blue toe syndrome is at high risk of limb loss and mortality despite treatment. Blue toe syndrome produces painful, cyanosed toes with preserved pedal pulses. It needs to be aware of blue toe syndrome. Careful history should reveal the diagnosis. Treatment is controversial, however, most believe that anticoagulation therapy should be avoided.

• Archives of Plastic Surgery
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• v.45 no.1
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• pp.62-68
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• 2018

Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated $90^{\circ}$ cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes.

• Journal of Trauma and Injury
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• v.32 no.3
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• pp.187-193
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• 2019

Many techniques have been developed for reconstruction of the hand; however, less attention has been paid to foot reconstruction techniques. In particular, reconstruction of the forefoot and big toe has been considered a minor procedure despite the importance of these body parts for standing and walking. Most of the weight load on the foot is concentrated on the forefoot and big toe, whereas the other toes have a minor role in weight bearing. Moreover, the forefoot and big toe are important for maintaining balance and supporting the body when changing directions. Recently, attention has been focused on the aesthetic appearance and functional aspects of the body, which are important considerations in the field of reconstructive surgery. In patients for whom flap reconstruction in the forefoot and big toe is planned, clinicians should pay close attention to flap survival as well as functional and cosmetic outcomes of surgery. In particular, it is important to assess the ability of the flap to withstand functional weight bearing and maintain sufficient durability under shearing force. Recovery of protective sensation in the forefoot area can reduce the risk of flap loss and promote rapid rehabilitation and functional recovery. Here, we report our experience with two cases of successful reconstruction of the forefoot and big toe with a sensate anterolateral thigh flap, with a review of the relevant literature.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.546-550
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• 2012

Background This study was designed to introduce the feasibility of toe tissue transfer without venous outflow for fingertip reconstruction. Methods Five cases of fingertip defects were treated successfully with this method. Four cases were traumatic fingertip defects, and one case was a hook-nail deformity. The lateral pulp of a great toe or medioinferior portion of a second toe was used as the donor site. An arterial pedicle was dissected only within the digit and anastomosis was performed within 2 cm around the defect margin. The digital nerve was repaired simultaneously. No additional dissection of the dorsal or volar pulp vein was performed in either the donor or recipient sites. Other surgical procedures were performed following conventional techniques. Postoperative venous congestion was monitored with pulp temperature, color, and degree of tissue oxygen saturation. Venous congestion was decompressed with a needle-puncture method intermittently, but did not require continuous external bleeding for salvage. Results Venous congestion was observed in all the flaps, but improved within 3 or 4 days postoperatively. The flap size was from $1.5{\times}1.5cm^2$ to $2.0{\times}3.0cm^2$. The mean surgical time was 2 hours and 20 minutes. A needle puncture was carried out every 2 hours during the first postoperative day, and then every 4 hours thereafter. The amount of blood loss during each puncture procedure was less than 0.2 mL. In the long-term follow-up, no flap atrophy was observed. Conclusions When used properly, the free toe tissue transfer without venous anastomosis method can be a treatment option for small defects on the fingertip area.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.7-13
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• 2004

Purpose: The purpose of this study was to present the clinical analysis of the results and our experience of the replantation surgery of the great toe. Materials and Methods: Between March 1995 and December 2002, twelve great toes, amputated from the distal phalanx to proximal phalanx were replanted. The complete types were 5 cases and incomplete types were 7 cases. The guillotine injuries were 4 cases and the crushing injuries were 8 cases. Results: Replantation in eleven out of the twelve amputations survived. The cases of revision were 3 cases due to venous thrombosis. Patients were followed up for a mean period of 2.2 years. The mean total active motion of the first MTP joint was $80^{\circ}$. The fusion of IP joint was carried in 7 cases due to the amputation of the IP joint level. The shortening of the replanted great toes was present, with average 0.9cm. The two point discrimination was 7-8mm except 2 cases with loss of nerve. Conclusion: Although replantation of the great toe remains to be controversial, replantation of the great toe should be considered in well-motivated patients because successful replantation regains an important component of the foot and good functional, cosmetic results.

• Journal of the Korean Orthopaedic Association
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• v.56 no.5
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• pp.450-454
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• 2021

A 75-year-old male patient without any significant medical and habitual risk factors for acute atherosclerosis obliterans except for hypertension was diagnosed with coronavirus disease 2019 with dyspnea, coughing, and mild fever. After a week of hospitalization, he complained of right foot pain and numbness. The symptoms were aggravated during the next week, resulting in a complete toe color change and loss of dorsalis artery pulse. Enhanced 3-dimensional computed tomography angiography revealed thrombus formation in the right common iliac artery and a loss of blood flow below the popliteal artery on both sides. The patient underwent percutaneous balloon angioplasty with stent insertion followed by medical therapy for anticoagulation. The clinical symptoms immediately were improved after the intervention, but the great toe necrosis was not recovered. Finally, amputation of the great toe was performed.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.267-271
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• 2019

A 70-year-old man complained imbalance while walking, inability to perform ankle flexion, and could not stand on tip-toe 3 months after injury. The ankle looked swollen with loss of Achilles contour and obvious gait disturbance. Magnetic resonance imaging shows a 5-cm Achilles tendon gap. Subsequently, surgery was performed to solve the neglected Achilles tendon rupture. Patient was put under general anesthesia with a regional block. Using a nontourniquet technique, a reconstructive procedure was performed using a half-width autologous Achilles tendon graft, which was attached to the calcaneal prominence with wire in a double strand Bunnell fashion. As for the proximal stump, double core Bunnell/modified Kessler suturing was carried out to suture the graft to Achilles stump. To increase the vascularization, an ipsilateral gastrocnemius fascial flap with a distally based-pedicle was harvested to wrap around the tendon graft. At a 6-month follow-up, the patient was able to stand on tip-toe and had also regained a normal gait.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.7-12
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• 1993

Traumatic loss of the fingers present significant functional disability and the index finger is an important component of hand function. Since 1900, many attempts and efforts have been done in reconstruction of amputated fingers with toes. Authors clinically analyzed 8 cases of toe-to-finger transfer in traumatic amputation of the index finger to be followed for more than one year at Korea University Hospital from August 1982 to December 1991. The results were as follows: 1. The most common cause of injury was mechanical accident in 7 of 8 cases. 2. Average interval between injury and operation was 8 year 3 months. 3. Average operation time was 5 hours 58 minutes and average ischemic time of transferred toe was 1 hour 52 minutes. 4. Skin flaps have survived in 7 of 8 cases, and the functional results in 6 of 8 cases were over than fair.