Dorsal Metatarsal Artery Flap Research Articles

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site. KEY WORDS: Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve, Medial Dorsal Cutaneous Nerve Flap, Intermediate Dorsal Cutaneous Nerve Flap, Soft Tissue Defects, Open Reduction And Internal Fixation Of Fibula, Arthroscopy, Local Anesthetic Block, First Dorsal Metatarsal Artery Flap, Defects In Distal Dorsalis Pedis, Compression And Entrapment Neuropathies.

Reverse first dorsal metatarsal artery flap for reconstruction of a soft tissue defect of the big toe. A case report

Reverse first dorsal metatarsal artery flap for reconstruction of a soft tissue defect of the big toe. A case report

Vascularized lymph vessel transplant (VLVT): our experience and lymphedema treatment algorithm

: Supermicrosurgical lymphaticovenicular anastomosis (LVA) and vascularized lymph node transplant (VLNT) are established surgical procedures for fluid-predominant extremity lymphedema. LVA is most effective for early disease, while VLNT is effective for more advanced lymphatic injury. However, the devastating complication of donor-site lymphedema has been reported following VLNT. Contour deformity caused by the bulky VLNT flaps further decreases the appeal of this procedure. Vascularized lymph vessel transplant (VLVT) has emerged as a promising new alternative to VLNT. This novel technique has challenged the accepted belief that incorporation of lymph nodes (LNs) into a flap is necessary for the physiologic treatment of advanced lymphedema. First described with the first dorsal metatarsal artery (FDMA) flap, the superficial circumflex iliac artery perforator (SCIP) and thoracodorsal artery perforator (TDAP) flaps were later on described as additional options for VLVT. Outcomes of VLVT have been found to be mostly equivalent to those of VLNT in alleviating symptoms and improving quality of life (QoL). By not sacrificing LNs, it theoretically reduces donor site morbidity. To date, donor-site lymphedema as a sequela of VLVT harvest has not been reported. As with other modalities for the treatment of lymphedema, an understanding of the progression of this disease and careful patient selection is imperative for the successful implementation of VLVT. A review of the literature, combined with the senior author’s experience with these novel techniques, was utilized to generate an updated algorithm for the surgical treatment of extremity lymphedema.

First Dorsal Metatarsal Artery Flap for Coverage of Distal Foot Wounds: A Case Discussion and Narrative Review

Reconstruction of distal foot and toe wounds present a challenging problem, as defects in this area are often associated with exposed tendons and bones, making split skin grafts impossible in many cases. There is also a need for any flap to achieve a smooth and nonbulky contour to allow for wearing of footwear and acceptable esthetic results. The first dorsal metatarsal artery (FDMA) flap has been increasingly described as a functional and effective method of managing relatively small distal foot and toe defects. We present a case study of our patient who underwent FDMA flap coverage of a big toe dorsum wound, and we also present a review of the literature. Of the 13 papers and 46 cases in the published literature, all flaps survived. Authors report good functional outcomes, with patients regaining ambulation and fitting footwear owing to the flap’s thin and pliable contour. Complications reported include 5 cases of superficial distal tip necrosis, all of which healed spontaneously. We conclude that the FDMA flap is a reliable, reproducible, and suitable coverage option for small distal foot, webspaces, and toe defects. They are relatively easy to perform and associated with good reported outcomes. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

The Innervated Distally Based First Dorsal Metatarsal Artery Flap with a Wide Pedicle for Reconstruction of a Great Toe Defect.

BackgroundIt is difficult for surgeons to reconstruct soft tissue defects of the great toe. This report aims to evaluate the utility and efficacy of innervated distally based first dorsal metatarsal artery (FDMA) flap with a wide pedicle for reconstruction of soft tissue defects of the great toe.MethodsThis is a retrospective report. Between January 2015 and December 2017, six cases of skin defect of the great toe were reconstructed with an innervated distally based FDMA flap with a wide pedicle. One case was excluded in this report because of chronic pain on the metatarsophalangeal joint due to osteoarthritis before the injury. A total of five cases were evaluated for flap survival and sensory recovery. The sensory recovery was investigated by two-point discrimination and Semmes-Weinstein monofilament tests. The average age of the selected patients was 40 years (range, 36 to 56 years), and the average size of the defect in the toe was 8.3 cm2 (range, 4 to 13.8 cm2). The average follow-up period was 29.4 months (range, 18 to 38 months).ResultsAll patients survived without any complications. The average two-point discrimination test value was 8.0 ± 0.89 mm (range, 7 to 9 mm), and the average value obtained from the Semmes-Weinstein monofilament test was 4.53 ± 0.33 (range, 4.17 to 4.93). The average residual pain score evaluated with a visual analog scale was 1 (range, 0 to 2). Two patients complained of stiffness in the great toe below 30° of total range of motion during the early stages after surgery, but this stiffness gradually improved after rehabilitation. The average range of motion of three patients with a remaining metatarsophalangeal joint after surgery was 80° (range, 70° to 90°). All five cases could walk regularly without any unique footwear at the final follow-up.ConclusionsThe innervated distally based FDMA flap with a wide pedicle could be a good alternative method for repair of soft tissue defects of the great toe.

Free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound

Objective To explore the surgical method and clinical effects of free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound. Methods From June 2010 to June 2015, 9 cases of thumb defect and adjacent finger soft tissue defects were treated using free second toe transplantation with the first dorsal metatarsal artery flap. The area of the first dorsal metatarsal artery flap ranged from 3.3 cm×2.0 cm to 5.2 cm×3.0 cm. Free skin grafts were used to repair donor site. Results Postoperatively tension blister at the distal end of the flap occurred in 1 case which were healed after removal of stitches and change of dressing. Other reconstructed fingers, flaps and skin grafts achieved primary healing. All the patients were follow-up for 6 to 32 months with an average of 15 months. All the flaps presented good appearance and elasticity with soft texture. The appearance and function of the reconstructed thumbs were good. There was no obvious effect on foot load walking. No skin ulcer occurred in donor site. Conclusion Free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound is an ideal method for repairing due to the reliable blood supply, safe operation and accordance to repair principle. Key words: Surgical flaps; Microsurgery; Tissue defects; Repair

Distally-based osteocutaneous dorsal metatarsal artery flap for hallux reconstruction

Reconstruction of complex defects of the distal portion of the foot remains a challenging problem for plastic surgeons. A traumatic case is presented where reconstruction of a complex plantar defect of the hallux was achieved using a distally-based osteocutaneous metatarsal artery flap based on the second dorsal metatarsal artery. Local flap repair is a viable reconstructive option for complex defects of the plantar surface of the forefoot.

Reversed dorsal metatarsal artery flap for reconstruction of a soft tissue defect of the big toe

Soft tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. A distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to cover the soft tissue defect following wide excision of melanoma of the big toe, is reported

Reversed dorsal metatarsal artery flap for reconstruction of a soft tissue defect of the big toe

Soft tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. A distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to cover the soft tissue defect following wide excision of melanoma of the big toe, is reported.

Coverage of donor web skin defect after second toe transfer by third dorsal metatarsal artery flap transposition

目的 介绍一种修复第二足趾再造手指后供区趾蹼皮肤缺损的新术式.方法 2003年1月-2006年12月,设计以第三跖背动脉远端趾蹼交通支为蒂的皮瓣,逆行转移修复28例切取第二足趾再造手指后供区趾蹼皮肤缺损的患者,皮瓣切取面积约5.0 cm×2.0 cm～7.0 cm×3.5 cm,术中将足背中皮神经与趾神经缝合,足背创面植皮修复.结果 术后随访时间为6个月～3年,皮瓣全部存活,感觉恢复良好.趾蹼外形满意,供足行走功能好.结论 第三跖背皮瓣逆行转移很好地解决了第二足趾再造术后供区趾蹼皮肤缺损的修复问题,最大程度地保护了供足的功能,减少了并发症,是一种安全、有效的新术式。

Digital reconstruction and donor site resurfacing: A two‐flap technique

Use of a great toe pulp flap is one of the methods to repair partial soft-tissue defect of the thumb or other digits. However, the conventional application of free skin grafts to close the donor site may bring donor-site morbidity. The authors present a two-flap technique that a reverse first dorsal metatarsal artery (FDMA) flap resurfaces the defect of the free great toe pulp flap. Six patients with soft-tissue defects of the thumbs or fingers were treated with this technique. Both the pulp and reverse flaps survived uneventfully after reconstruction of the thumbs and fingers. The reverse flap to resurface the donor site on the great toe was sensate and durable. Satisfactory appearance and function were gained in all patients. Results revealed that this technique can be accepted as an alternative method when treating soft tissue defect of the thumb or finger.

Reverse First Dorsal Metatarsal Artery Flap for Reconstruction of Traumatic Defects of Dorsal Great Toe

Soft-tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. This study investigates the feasibility and reliability of reverse first dorsal metatarsal artery flap (FDMA) for reconstruction of the dorsal great toe soft-tissue defects. Six male patients with dorsal great toe defects (mean 2.2 x 4.7 cm) underwent reconstruction using the reverse FDMA flap. Preoperative angiography was performed to confirm the existence and patency of the distal communicating artery between the FDMA and plantar metatarsal artery. The flap was raised by dividing the dorsalis pedis artery and proximal communicating arteries and rotated 180 degrees to cover the defect. All flaps survived completely. Mean follow-up time was 3.3 months. Painless full range of motion was recovered and the contour of the flap was satisfactory. All patients returned to their normal walking and running activities and none necessitated special footwear. No donor-site morbidity was encountered. Reverse FDMA flap presents a viable alternative for reconstruction of soft-tissue defects of dorsal great toe when local flap coverage is required. Because of anatomic variations, preoperative angiography is necessary for successful reconstruction, especially in patients with comorbidities affecting patency of their vasculature.

Reconstruction of distal foot wounds with reverse first dorsal metatarsal artery flap

Reconstruction of the distal portion of the foot has always represented a difficult problem in plastic surgery. We report a distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to treat the distal portion of the foot in eight patients. The size of flaps ranged from 3 cm × 4 cm to 6 cm × 7 cm. In seven patients, the transferred flaps survived completely and in one flap there was superficial marginal necrosis. There was no donor site morbidity. All the patients had no difficulty in wearing shoes and were walking within 6 weeks. We suggest that the reverse first dorsal metatarsal artery flaps is a good option to reconstruct the wound of distal foot.

Reconstruction of Diabetic Foot Ulcers by Regional Flap Surgery

Purpose : The purpose of this study was to evaluate the value of regional flap surgery for diabetic foot ulcers combined with infection or bone and tendon exposure. Materials and Methods : We reviewed eight patients, nine cases of diabetic foot ulcers, which were treated by regional flap surgery. There were two Wagner’s grade 2 ulcers and six Wagner's grade 3 ulcers. We performed four reversed sural artery neurocutaneous flaps, two lateral supramalleolar flaps, two medial plantar artery flaps and one first dorsal metatarsal artery flap. Results : Seven of nine flaps completely survived after regional flap surgery. One partial and one complete flap necrosis occurred. One partially necrotized flap needed an additional skin graft. One completely necrotized flap needed free rectus abdominis myocutaneous flap surgery. There were two new ulcers, which were treated by free flap surgery. No patient needed amputation above the ankle joint. Conclusion : Satisfactory results were obtained by regional flap surgery for diabetic foot ulcers. Regional flap surgery is regarded as an effective treatment modality for diabetic foot ulcer combined with bone and tendon exposure with infection.

A new technique for the correction of syndactyly of the toes

A new technique is described for the correction of complete syndactyly of the toes. In this technique, a distally-based dorsal metatarsal artery flap is used to cover one side of the released toes. The other side of the toe is covered with a laterally based dorsal toe flap. A case of complete syndactyly between the second toe and and the third toe is presented.

A distally based island first dorsal metatarsal artery flap for the coverage of a distal plantar defect

An intractable plantar ulcer of the great toe was successfully covered with a distally based island first dorsal metatarsal artery flap. Common dorsal digital veins served as venous drainage for the flap. The results show that this flap can be used as a reliable alternative to conventional techniques to repair a distal foot defect.