Applied anatomy of the first metatarsal proximal perforator-based neurocutaneous vascular flap

Abstract

Objective To explore the anatomical characteristics of mediate dorsal pedal cutaneous nerve and its nutritional vessels to provide anatomical basis of the perforator pedicle flap based on the medial dorsal pedal neurocutaneous vessels for repairing the forefoot soft-tissue defects. Methods From December, 2016 to April, 2017, the following contents were investigated in 30 adult feet specimens perfused with red latex: ①The course, branches and distribution of the medial dorsal pedal cutaneous nerve. ②The origin, course, branches and distribution of the nutrient vessels of the medial dorsal pedal neurocutaneous vessels. Mimic operation was performed on 1 fresh specimen. Results ①The mediate dorsal pedal cutaneous nerve mainly arose from the medial branch of the superficial peroneal nerve and processed forward for a distance of (2.5±0.4) cm under the surface of the inferior extensor retinaculum, and then divided into the mediate dorsal branch, the 1st and 2nd dorsal metatarsal branch over part of the dorsal pedal and digital skin. ②The medial dorsal pedal neurocutaneous vessels were multiple segmental and polyphyletic, mainly include dorsalis pedis artery proximal perforator, the first metatarsal proximal perforator, the tibial proper plantar digital artery of the great toe and the perforater of the second toe web artery, of which the first metatarsal proximal perforator was most associated with operating methods. The first metatarsal proximal perforator perforate through the deep fascia to the subcutaneous area within the range of 1.0-2.0 cm near the proximal first plantar gap, the piercing point of which on deep fascia was constant,and the anatomical plane of the first metatarsal proximal perforator was higher than that of both the perforator of the toe web artery and the tibial proper plantar digital artery of the great toe. The first metatarsal proximal perforator divide into a large number of branches, which closely anastomose with adjacent perforators and other medial dorsal pedal neurocutaneous vessels. ③Simulated surgery showed that the first metatarsal proximal perforation pedicle flap to meet the forefoot soft tissue defect repair. Conclusion The first metatarsal proximal perforator is constant in piercing point and reliable in blood supply, and it have a higher anatomical plane than that of both the perforator of the toe web artery and the tibial proper plantar digital artery of the great toe. The first metatarsal proximal perforator-based medial dorsal pedal neurocutaneous vascular flap can be transferred to repair the soft-tissue defects of forefoot. Key words: First metatarsal proximal perforator; Medical dorsal pedal cutaneous nerve; Surgical flaps; Applied anatomy