Anatomical analysis of the cause of skin necrosis of the great toe after transplantation of the great toe nail flap.

Necrosis of skin on the medial side of the great toe has been a significant complication of the great toe nail flap. To investigate the reason for this, a study of the blood supply of the medial side of the great toe was carried out on 55 feet with the injection of red latex into the arteries and on 13 vascular cast specimens. It was found that, after the blood vessels from the plantar and dorsal sides of the great toe are severed during the operation, the skin of the medial side of the great toe is mainly supplied by the medial vascular network at the head of the first metatarsal bone. It is clear that the blood supply from this network may sometimes be insufficient to nourish the skin. It is suggested that the operative incision should be changed so as to increase the blood supply to the medial vascular network which may decrease the incidence of skin necrosis.