J Korean Foot Ankle Soc.  2019 Dec;23(4):208-211. 10.14193/jkfas.2019.23.4.208.

Treatment Using a Single-Lobed Rotation Flap in Diabetic Forefoot Ulceration: Five Case Reports

• Kim JB
• Lee BJ
• Kim CU
• Jung D

• KMID: 2465946
• DOI: http://doi.org/10.14193/jkfas.2019.23.4.208

Abstract

Diabetic foot ulcers can progress to the point where amputation is needed, and so these ulcers require active treatment. Skin grafts or flaps can be performed for coverage of this type of ulcer. Local flap surgery is relatively easy to perform and good results have been previously reported. We performed single-lobed rotation flap on 5 cases of forefoot ulcer around the site of weight bearing. The location of the foot ulcers was the medial part of the first metatarsophalangeal joint in all the patients. The mean size of the defect was 4.70 cm2. Managing of ulcers, controlling of diabetes and infection, and improving of peripheral blood flow were performed before surgery. In two cases, infection progressed to the articular cartilage and so metatarsophalangeal joint fusions were performed simultaneously. All the cases were completely transplanted. There was no recurrence of the ulcers, and all the patients were able to walk.

Keyword

Forefoot; Diabetes; Ulceration; Local flap

MeSH Terms

Amputation
Cartilage, Articular
Diabetic Foot
Foot Ulcer
Humans
Metatarsophalangeal Joint
Recurrence
Skin
Transplants
Ulcer*
Weight-Bearing

Figure

• 

  Figure 1 Single-lobed rotation flap. (A) Type 1: the excision of the defect is arranged so that right angle (90-degree angle) is formed at the base of the defect for the start of the flap. (B) Type 2: the excision of the defect is arranged so that 60-degree angle is formed at the base of the defect.

• 

  Figure 2 The flap was harvested as shown in this figure.

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  Figure 3 (A) Skin closure of round defect. Preoperative photograph showing a round defect on medial side of first metatarsophalangeal joint (MTPJ). (B) Postoperative photograph showing a well covered defect of the MTPJ by single-lobed rotation flap, type 1. (C) Postoperative photograph showing good appearance of the foot at the final follow-up.

• 

  Figure 4 (A) Skin closure of oval defect. Preoperative photograph showing an oval defect on medial side of first metatarsophalangeal joint (MTPJ). (B) Postoperative photograph showing a well covered defect of the MTPJ by single-lobed rotation flap, type 2. (C) Postoperative photograph showing good appearance of the foot at the final follow-up. (D) Plain radiograph showing arthrodesis of the 1st MTPJ with headless screws.

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