From the Guidelines
Dorsal flap foot amputation is a viable surgical option for severe foot infections, gangrene, trauma, or vascular disease, and should be considered when more distal tissue is not viable, as it provides a durable stump that can better withstand pressure during ambulation with prosthetics. The procedure involves careful marking of the dorsal flap, followed by incision, preservation of blood supply to the flap, bone resection at the appropriate level, and meticulous closure with the dorsal flap covering the amputation site 1.
Key Considerations
- The decision to perform a dorsal flap foot amputation should be made by a multidisciplinary team, taking into account the patient's overall health, the presence of infection, and the degree of ischemia and tissue loss 1.
- Post-operative care is crucial to prevent complications and promote healing, and should include elevation of the extremity, pain management, wound care with regular dressing changes, and prophylactic antibiotics if infection risk is high.
- Physical therapy should begin as soon as medically appropriate to maintain strength and prepare for potential prosthetic fitting.
Surgical Technique
- The dorsal flap technique is preferred in many cases because the dorsal skin is often better preserved than plantar tissue in patients with vascular compromise 1.
- The procedure should be performed by a surgeon with thorough knowledge of the anatomy of the foot and the ways in which infection spreads through its fascial planes 1.
- Bone resection and amputation are often necessary when there is extensive soft tissue necrosis or to provide a more functional foot 1.
Patient Outcomes
- The goal of dorsal flap foot amputation is to achieve a healed wound with a functional limb, and to minimize the risk of complications and mortality 1.
- Patient education, appropriate extremity pressure offloading with prescription shoes, and foot surveillance clinical examinations are essential to reducing wound recurrence, especially in patients with diabetes and neuropathy who have had chronic limb-threatening ischemia (CLTI) 1.
From the Research
Dorsal Flap Foot Amputation
- Dorsal flap foot amputation is a complex procedure that requires careful consideration of wound management and reconstruction techniques.
- A study published in 2004 2 presented a case where an extensive avulsion injury of the dorsum of the foot with amputation of the fourth and fifth toe was treated by defatting the avulsed flap and reattachment as a full-thickness graft, resulting in uneventful healing and no skin necrosis.
- Another study published in 2021 3 described the use of the reverse extensor digitorum brevis flap for small- to medium-sized defects on the dorsum of the foot, which was found to be a reliable and effective option with robust vascularity and minimal donor site morbidity.
Wound Management
- Negative pressure wound therapy (NPWT) has been shown to be an effective treatment for complex diabetic foot wounds, including those resulting from partial foot amputation 4, 5.
- A study published in 2005 4 found that NPWT delivered by the Vacuum Assisted Closure (VAC) Therapy System resulted in a higher proportion of healed wounds and faster healing rates compared to standard moist wound care.
- Another study published in 2007 5 found that NPWT was effective in treating both acute and chronic wounds after partial foot amputation, with no significant difference in healing rates between the two types of wounds.
Reconstruction Techniques
- The lateral lesser toe fillet flap is a reproducible technique that can be used for diabetic foot soft tissue closure, providing a favorable option for wound management 6.
- The reverse extensor digitorum brevis flap is another option for reconstructing small- to medium-sized defects on the dorsum of the foot, offering a reliable and effective solution with minimal donor site morbidity 3.