Arch Hand Microsurg.  2023 Jun;28(2):106-109. 10.12790/ahm.23.0010.

Reconstruction of a soft tissue defect in the toe using a serratus anterior fascia free flap: a case report

• Kim DK
• Kim YH

• KMID: 2542561
• DOI: http://doi.org/10.12790/ahm.23.0010

Abstract

Toe injuries frequently occur as traumatic or oncologic defects. Compared with finger reconstruction, toe reconstruction has been rarely reported in the literature, because of the difficulty of toes’ relatively thin soft tissue envelope, their requirement for relatively challenging surgical techniques, and the slight improvements in gait. Therefore, toe reconstruction can be challenging for plastic surgeons, especially in cases with exposure of a tendon, bone, or joint. Herein, we present a case study of a 54-year-old woman with squamous cell carcinoma in situ (Bowen disease) that subsequently resulted in a defect on her second toe. A serratus anterior fascia free flap could be a good option for toe reconstruction due to its large caliber, lengthy pedicle, relatively easy dissection, and thin muscle bulk. We present our unique experience using the serratus anterior fascia free flap for the reconstruction of an oncologic toe defect.

Keyword

Free tissue flaps; Serratus anterior fascia; Toe reconstruction

Figure

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  Fig. 1. A 54-year-old woman with a squamous cell carcinoma in situ (Bowen disease) measuring about 2.5×1.5 cm2 on the lateral side of her right second toe.

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  Fig. 2. (A) Toe defect was approximately 3.5×2.0 cm2 after wide excision of cancer. (B) A serratus anterior fascia flap of about 4.0×2.5 cm2 and a pedicle of roughly 6 cm was harvested. (C) After anastomosis, acellular dermal matrix was applied to the muscle flap, and then a split-thickness skin graft was performed. The fascia free flap demonstrated relatively good matching with the surrounding tissues in terms of color, shape, and texture.

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  Fig. 3. The donor site in the right axillary area was closed primarily without tension. The linear incision was about 11 cm.

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  Fig. 4. The fascia flap engrafted well overall, but the skin graft from about one-third of the proximal portion did not take well.

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  Fig. 5. Long-term follow-up view after full-thickness skin graft revision showed good coverage with a mild hypertrophic scar.

Reference

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