Rationalizing the Vascular Anatomy for Oblique Osteotomy of the Metatarsal Head during Toe/Joint Transfers of the Metatarsophalangeal Joint.

Abstract

The metatarsophalangeal joint (MTPJ) of the lessor toe has been used to reconstruct the metacarpophalangeal joint. When an oblique osteotomy of the metatarsal head is performed, the orientation of the vascular pedicle is crucial to preserve the blood supply to the MTPJ. This study was conducted to identify the path of the nutrient artery to the MTPJ. We reviewed our operative records in consecutive series of 45 patients during toe or joint harvest. Retrograde dissection of the vascular pedicle was performed starting from the distal communicating artery at the first webspace toward the first dorsal metatarsal and first plantar metatarsal arteries. All the vessels related to the MTPJ were explored and ligated if the MTPJ was not included in the flap. The condylar branches to the proximal phalanx and the metaphyseal branches to the second metatarsus were barely identifiable during the dissections. The articular branch running perpendicularly from the plantar artery toward the plantar surface of MTPJ was verified in all cases. The articular branches originated either from the first plantar metatarsal artery (92.1%) or from the tibial plantar digital artery (7.9%). The external diameter of the articular branches was around 0.5-1 mm. When the articular branch was included and preserved, the metatarsal heads oozed immediately after the flap was reperfused. The study demonstrated the constant and sizable articular branch of the MTPJ that originates from the plantar artery system. The consistency of the vascular anatomy enables oblique osteotomies of the metatarsal head to be performed without fear of injury to the pedicle.