The procedure for amputation through the hallux interphalangeal joint is performed in the operating theatre under local anaesthesia and sedation, with a Penrose drain applied as a tourniquet around the base of the great toe. A long plantar and short dorsal skin flap is fashioned. The transverse dorsal skin incision is made, proximal to the posterior nail fold, at the level of the interphalangeal joint. The incision extends from medial to lateral and is then directed distally around the end of the toe, to form a long plantar flap. The toe is disarticulated at the interphalangeal joint and all tissues are excised (nail plate, nail bed,
Fig. 8.22 Hallux amputation in a neuropathic patient, (a) Clinical appearance 5 months following disarticulation of the hallux at the metatarsophalangeal joint, with medial and lateral skin flaps for closure. There is moderate to severe swelling of the 2nd and 3rd toes, (b) Anteroposterior radiograph reveals pathological fractures of the proximal phalanges of the 2nd and 3rd toes.
nail matrix and distal phalanx). A long plantar flap is fashioned (trimmed to fit), and sutured without tension to the short dorsal flap with 4-0 nylon simple interrupted sutures. If the toe is infected at the time of surgery, the wound should be left open or very loosely approximated. The patient can then be brought back to the operating theatre for delayed wound closure when the infection is resolved.
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