Should Every Mummified Toe Be Amputated? Toe Preservation With a Perforator Flap

Background: Peripheral gangrene, caused by various etiologies, including diabetes, peripheral artery disease, trauma, and vasopressor use, poses significant challenges. Traditional management often involves proximal amputation, which carries a high risk of major amputation and mortality. This study evaluated the efficacy of perforator flaps for toe preservation in patients with toe necrosis. Methods: Six patients with peripheral gangrene, affecting a total of 9 toes, were retrospectively analyzed. The surgical procedure entailed only soft tissue debridement with minimal to no bone amputation and subsequent coverage using thin perforator flaps. Patient demographics, surgical details, flap outcomes, and additional procedures were also reviewed. Results: Despite potential technical challenges, all but 1 flap survived, with 1 patient requiring partial flap loss management using a full-thickness skin graft. Most patients exhibited successful infection control and wound healing, with a significant emphasis on preserving toe functionality and length. Conclusions: This study demonstrated that toe preservation with "encircling"perforator flaps is a viable alternative to traditional proximal amputation for patients with peripheral gangrene. This approach may provide a potential benefit in preserving limb length, but careful patient selection and surgical precision are paramount for achieving favorable outcomes.