Great Toe Reconstruction With a Chimeric Flap Based on Superficial Circumflex Iliac Artery

Summary:

The great toe is crucial in weight-bearing and gait propulsion, making reconstruction of its composite defects particularly challenging in high-risk patients. We present a case of a 59-year-old man with poorly controlled diabetes and osteomyelitis of the left distal phalanx. Thorough debridement revealed complete loss of the distal phalanx, full-thickness dorsal soft tissue, and exposed extensor tendon. We used a chimeric flap based on the superficial and deep branches of the superficial circumflex iliac artery (SCIA) as an improved alternative to the traditional deep circumflex iliac artery flap, which was particularly effective in this patient. The flap provided a vascularized iliac bone segment and a thin skin paddle based on the deep branch of the SCIA. The harvested pedicle provided sufficient length for straightforward microanastomoses to the dorsalis pedis vessels. The bone segment was securely fixed to the residual proximal phalanx using a headless compression screw. The postoperative course was uneventful with complete flap survival. At the 6-month follow-up, the patient’s excellent functional outcome was confirmed by the Japanese Society for Surgery of the Foot score of 92 out of 100, achieving painless full weight-bearing ambulation. This case suggests that the chimeric flap based on the SCIA is a valuable technique for small composite defects, including those of the distal phalanx, providing effective reconstruction with minimal donor-site morbidity compared with traditional options. The technique is advantageous in patients who are compromised, in whom donor-site complications and recipient-site requirements for thin, pliable coverage must be carefully balanced.