Postoperative skin necrosis occurs due to various causes, including infections, lack of oxygenation, underlying diseases, and lack of nutrition. Therefore, a thorough evaluation of the cause of skin necrosis should be conducted. In the present case, the patient underwent disarticulation of the interphalangeal joint of the right first toe by an orthopedic surgeon and developed postoperative skin necrosis. Through physical examination, imaging studies, and detailed medical history evaluation, the patient was diagnosed with thromboangiitis obliterans, also known as Buerger’s disease. After 4 months of medication for Buerger’s disease and smoking cessation, the wound healed without complications or recurrence. Therefore, in cases of untreatable chronic wounds in young and heavy smoking patients, Buerger’s disease should be suspected as a potential cause.