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Purpose:   Fillet flap is a “spare part” concept. This technique allows the defect to be covered without donor site morbidity. Over the past 5 years, there were 107 diabetic foot cases of one-toe fillet flap in our hospital. After the operation, in some patients, there was necrosis of the adjacent toe that required additional amputation. The aim of our study was to determine the cause of necrosis of the adjacent toe after fillet flap.Methods:   The patients were divided into two groups. One group had no necrosis of the adjacent toe (group A) after the operation, and the other group had necrosis of the adjacent toe that required additional amputation after the operation (group B). Then, to confirm the cause of the additional necrosis of the adjacent toe, χ  2  tests, Fisher’s tests, and logistic regression tests were performed.Results:   A total of 107 patients were included, and 48 patients needed additional amputation. The logistic regression test revealed that a fillet flap at the metatarsophalangeal joint (MTPJ), horizontal sutures, and a fillet flap at the second toe were significant risk factors for developing necrosis.Conclusions:   If a fillet flap with a second toe, fillet flap on MTPJ level and horizontal closure after fillet flap is needed, the chance of developing necrosis of the adjacent toe and additional revisional surgery must be communicated preoperatively.

Risk of necrosis in the adjacent toe after one-toe fillet flap in diabetic foot: Retrospective study of 107 cases over 5 years