Preservation of 1st Metatarsal Head Blood Supply with Minimally Invasive Chevron vs Transverse Osteotomy

Abstract

Introduction/Purpose: The purpose of this study is to evaluate damage to the first dorsal metatarsal artery, first plantar metatarsal artery, and the superficial branch of the medial plantar artery after different types of minimally invasive osteotomies are performed on cadaveric specimen. Methods: 10 cadaveric feet were injected with methylene blue dye to aid in visualizing the vessels. We then randomly divided the samples into 2 groups of 5. Group A received a chevron osteotomy and group B received a transverse cut osteotomy. We then dissected the specimen and studied the damage to the first metatarsal head vascular plexus and recorded the distance of our cuts from the center of the metatarsal head. We plan to take 6 additional cadaveric feet and inject them with silicone based dye prior to performing osteotomies on these additional specimen; 3 chevron and 3 transverse. We will then dissect these specimen in a similar manner to evaluate for vascular plexus damage. We believe this will improve our scientific process. Results: After careful dissection we did not find major damage to the vascular plexus in any of the specimen. Please note: we will be continuing this project with additional cadaveric specimen and improved dye techniques. Conclusion: We did not find a difference in vascular risk between MIS transverse and chevron osteotomy techniques. If the primary safe zone guidelines are respected and care is taken to avoid common pitfalls, surgeons can confidently choose between the two constructs without accommodating further AVN risk. Gross Dissection Displaying First Dorsal Metatarsal Artery