Free Dorsalis Pedis Flap Research Articles

Repairment of skin defects of penetrating palm wound by application of free string-type dorsalis pedis flap and anterior malleolus flap

Objective To investigate the clinical outcome of the feasible method of the free string type dorsalis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm. Methods From May, 2011 to January, 2017, the anterior combined ankle flap of the ankle were used to repair skin defects of 16 cases who sutained penetrating wounds of palm. Results All 32 flaps in the 16 cases survived. Follow-up were done from 2 months to 2 years after operation. Bone healing was achieved in all cases. Two-point discrimination recovered to 6-8mm. Total active range of motion of the fingers reached 75% of the normal side. Both appearance and texture of the flaps were good. Both the appearances of the repaired palms and the functional recovery were satisfactory. The function assessment of the hand was excellent in 8 cases, good in 5 cases, fine in 2 cases and poor in 1 case. The eligible rate was 81.25%. Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant, which facilitate the dissection of the flaps during operation. The repairement of skin defects at two sides, both the palm and the back of hand, can be achieved via one operation. Therefore, the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm. Key words: Anterior malleolus flap; Dorsalis pedis flap; Penetrating wound of palm; Reconstruction

A New Surgical Procedure for Penile Reconstruction by Combined Free Radial Forearm Flap and Dorsalis Pedis Flap

To introduce a new surgical procedure for penile reconstruction, emphasizing both the aesthetic appearance and the function by combined free radial forearm flap and dorsalis pedis flap. In this procedure, the penis was subdivided into 2 anatomic subunits: the penile shaft and the glans penis. A sequential innervated radial forearm free flap was combined with a dorsalis pedis free flap to reconstruct the penile shaft and the glans, separately. Cartilage prosthesis was implanted at the same time. Since May 2011, 14 biologically male patients with total penile losses by various reasons were treated with this procedure. Patient satisfaction was evaluated by questionnaire, and sensory testing was performed. The ages of the patients ranged between 21 and 53 years (mean, 35.2 years). The average follow-up period was 38.1 months (range, 25.5-56 months). Twenty-five flaps in 11 patients were 100% viable. One dorsalis pedis flap in a patient underwent partial necrosis. There were no cases of urethral fistula or urethral stenosis, but 1 case of prosthesis infection and 1 case of abdominal hernia were recorded. The sensation of the neophallus recovered 3-6 months after surgery, and the patient satisfaction rate was quite high. The new surgical procedure of combined free radial forearm flap and dorsalis pedis flap for penile reconstruction achieves both satisfactory aesthetic and functional results. We recommend this procedure as an alternative ideal method for total penile reconstruction.

Clinical Application of the Dorsalis Pedis Free Flap for Reconstruction of Oral Cancer Defects

The purposes of this study were to evaluate the clinical application and efficacy of the dorsalis pedis fasciocutaneous flap in the reconstruction of oral cavity defects and to assess the associated donor-site morbidity. From September 2009 to December 2012, 7 patients with associated oral cavity defects resulting from tumor resection underwent reconstruction with a dorsalis pedis fasciocutaneous flap. Surgical anatomy and harvesting procedure of the dorsalis pedis flap are described. Special consideration was given to the associated donor-site morbidity. All flaps survived without any complications. All 7 flaps were based on the dorsalis pedis artery and the greater saphenous vein for perfusion and drainage respectively. In all 7 cases, the donor site was closed with a full-thickness skin graft, with no associated healing complications or functional deficit of the foot. The resulting scar was well hidden in the lower extremity. The dorsalis pedis fasciocutaneous flap is a thin and pliable flap sharing many similarities with the radial forearm flap, thus making it ideal for intraoral reconstruction. Proper intraoperative and postoperative care of the donor site can result in minimal morbidity, as shown in this study. This flap may provide an ideal alternative to the radial forearm free flap, with the added advantages of a well-hidden scar and a high level of patient satisfaction.

Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction.

Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result.

Surgical Technique: Repair of Forefoot Skin and Soft Tissue Defects Using a Lateral Tarsal Flap With a Reverse Dorsalis Pedis Artery Pedicle: A Retrospective Study of 11 Patients

Various authors have proposed flaps to reconstruct traumatic forefoot skin and soft tissue defects, especially with exposure of tendon and/or bone although which is best for particular circumstances is unclear. The indications for the technique were a forefoot defect area of no more than 8-cm × 8-cm and a well-preserved lateral tarsal (LT) donor site. The injured tendons were repaired using tendon grafts. The free dorsalis pedis flap was outlined by centering it on the cutaneous branch of the LT artery and tailoring it to the size of the wound, allowing 0.5-cm margins in length and width. The flap was rotated around the plantar perforating branch of the dorsalis pedis artery (DPA) to cover the forefoot defect. The lateral dorsalis pedis cutaneous nerve was anastomosed with the recipient plantar nerve stump. The donor site was covered with an inguinal, full-thickness skin graft. Traumatic forefoot skin and soft tissue defects with exposure of the tendon and/or bone involving 11 feet in 11 patients (mean age, 32 years) were covered using a LT flap with a reversed DPA pedicle. Three patients with forefoot defects underwent emergency repair within 8 hours of injury, whereas eight patients required delayed repair. All patients were followed up for at least 6 months (mean, 13 months; range, 6-24 months). All flaps survived uneventfully, except for two that had superficial marginal necrosis or severe venous insufficiency. All skin grafts covering the donor sites survived and all wounds healed. None of the patients had restricted standing or walking at followups. The two-point discrimination was 4 mm to 10 mm at 6 months postoperative. The mean hallux-metatarsophalangeal-interphalangeal scale score was 93 points (range, 87-98 points). Our observations suggest the LT flap with a reversed DPA pedicle is a reasonable option for repair of traumatic forefoot skin and soft tissue defects with exposure of tendon and/or bone but a well-preserved LT donor site and is associated with minimal morbidity.

Reconstruction of Severe Anophthalmic Orbits and Atresic Eye Sockets After Enucleation and Irradiation of Retinoblastoma by Vascular Anastomosed Free Dorsalis Pedis Flaps' Transplantation

Retinoblastoma is a common malignant intraocular tumor in childhood, and most patients require enucleation or exenteration even with irradiation. Severe anophthalmic orbits and atresic eye sockets are not rare. We conducted a retrospective study to evaluate the results of surgical management of reconstruction of severe anophthalmic orbits and atresic eye sockets with vascular anastomosed free dorsalis pedis flap transplantation. There were 5 patients (5 eyes) who underwent reconstructive surgery of severe anophthalmic orbits and atresic eye sockets after enucleation and irradiation of retinoblastoma in our hospital during the 3 years. All patients had enucleation and irradiation immediately after the retinoblastoma was diagnosed and had never worn artificial eyes because of the atresic eye sockets. Vascular anastomosed free dorsalis pedis flaps, whose dimensions were typically 6.5 × 5.5 cm(2), were transplanted to reconstruct the severe anophthalmic orbits and atresic eye sockets. The donor sites were covered by free abdominal skin flaps. All the vascular anastomosed free dorsalis pedis flaps were valid after more than 6 months of follow-up. And then all the 5 patients underwent secondary autogenous dermal fat implantation to augment the supraorbital area depression. After the 2-stage reconstruction surgery, the dimensions of the eye sockets were adequate, and all patients were able to wear their prosthesis and had a satisfactory cosmetic result. Implantation of alloplastic materials is not recommended because of insufficient blood supply of the irradiated orbital area.

Repairment of skin defects secondary to penetrating wound of palm with the application of free string-type dorsalis pedis flap and anterior malleolus flap

Objective To investigate the clinical outcome of the feasible method of the free string type dorsalis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm. Methods From May 2004 to July 2009, the free string-type dorsalis pedis flap and anterior malleolus flap were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.Results All 32 flaps in the 16 cases were all survived. Follow-ups were done from 6 months to 2 years after operation. Both the appearances of the repaired palms and the functional recovery were satisfactory. The function assessment of the hand was excellent in 8 cases, good in 5 cases, fine in 2 cases and poor in 1 case.The eligible rate was 81.25%. Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant, which facilitate the dissection of the flaps during operation. The repairement of skin defects at two sides, both the palm and the back of hand, can be achieved via one operation. Therefore, the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm. Key words: Anterior malleolus flap; Dorsalis pedis flap; Transplantation; Penetrating wound of palm; Microsurgical operation

Dorsalis pedis free flap in oromandibular reconstruction

This paper reports the free dorsalis pedis flap as a fasciocutaneous and osteocutaneous flap in oromandibular reconstruction. The authors present a 7-year series of nine patients with squamous cell carcinoma of oral cavity with extensive soft tissue/soft tissue and bone defect in whom this flap was used for intraoral reconstruction. The free fasciocutaneous flap (two neurosensate) was used in eight patients, and in one patient, a free osteocutaneous flap was required. The follow-up period ranged from 2 and 7 years. No ischemic flap complications occurred and a good anatomical and functional reconstruction was achieved in the majority of patients. There was no significant donor area functional disability. One death occurred in the early post-operative period due to multi-organic failure and four deaths in the follow-up period due to recurrence of the oncological disease. The dorsalis pedis free flap was found to be a good alternative tool for reconstruction of the anterior floor of mouth defects (including marginal mandibular defects). This was also used for anterolateral intraoral soft tissue defects. The donor area morbidity is not problem-free, but with good planning and careful flap dissection, it is possible to minimize the sequelae to a very acceptable level.

Repair of soft tissue defect on dorsum of the hand with free dorsalis pedis flap

Objective To evaluate the clinical outcomes of repairing soft tissue defect on dorsum of the hand by free dorsalis pedis flap transfer. Methods Ten cases of soft tissue defects on dorsum of the hand were treated. Dorsalis pedis flap including the superficial peroneal nerve was harvested and transferred to cover the defects. In one of the 10 cases, the 3rd and 4th toe extensor tendons were also included in the flap. In the other case, the second toe was transferred simultaneously to reconstruct the middle finger. The sizes of the harvested flaps ranged from 5 cm x 4 cm to 21 cm 12 cm. Results All 10 flaps survived. Postoperative vascular crisis occurred in 1 ease. Surgical exploration revealed venous thrombosis. The flap survived after resection of the thrombotic site and vascular re-anastomosis. Postoperative follow up period was 6 to 24 months. In 9 eases the flaps were not bulky. The texture and color of the skin were near normal. Partial recovery of pain, temperature and touch sensation was observed. In 1 ease the skin was dark and hard. Necrosis of skin grafts at the donor site with exposed tendons was seen in 3 cases. One case healed secondarily after dressing change; one was treated by transferring medial fascial flap from the lower leg; one case was repaired with medial tarsal island flap. Conclusion Composite dorsalis pedis flap is an ideal mehed to repair defects of skin, tendon and nerve on dorsum of the hand. Key words: Flaps; Hand injuries; Transplantation; Repair

The Versatility of the Dorsalis Pedis Compound Free Flap in Hand Reconstruction

The dorsalis pedis flap has demonstrated considerable versatility in the reconstruction of composite soft-tissue defects of the hand. It has the potential benefit of being thin and pliable, having reliable vascularity, and being relatively easy to harvest. However, the flap has been plagued by questions of its reliability and concerns over the donor site. An institutional review of dorsalis pedis free flap (DPFF) reconstructions of the hand was performed for the interval 1996-2006. A modified Hallock classification scheme was used to stratify the flaps. A total of 20 DPFF reconstructions of the hand were identified. There were 14 male and 6 female patients aged 20 to 53 years. The ensuing defects included secondary web contracture as well as primary amputations and exposed bony and tendinous structures. The flaps ranged in size from 15 cm2 to 110 cm2. Flap survival was 100% except one partial flap necrosis treated with a secondary skin graft. Partial donor skin graft loss was noted in 5 patients and 3 of them required a secondary resurfacing of the donor site. Functional data on 6 of 7 patients with web space contracture reconstruction showed improvements. DPFF provides durable reconstruction for composite soft-tissue defects of the hand without unduly sacrificing function or form. Donor site complications in our series were minor.

REPAIR OF A LARGE PHARYNGOCUTANEOUS FISTULA WITH THE FREE DORSALIS PEDIS FLAP

Ataturk University Medical Faculty, Department of Plastic and Reconstructive Surgery¹, Erzurum, Yuzuncu Yil University Faculty of Medicine, Plastic and Reconstructive Surgery2 Van, Turkey Postoperative pharyngocutaneous fistulas are the relatively frequent complications of total laryngo-oesophagectomy. Despite various treatment strategies have been mentioned in the literature, ideal method for closure of the large pharyngocutaneous fistulas is still controversial. In this report we have succesfully closed a large pharyngocutaneous fistula with free dorsalis pedis flap after ablation of oesophageal cancer

Reconstruction of the anophthalmic orbit by orbital osteotomy and free flap transfer

It is challenging to perform an adequate reconstruction of the post enucleation irradiated orbit of patients with rentinoblastoma. Rebuilding of the orbital structure, reconstruction of the eye socket and restoration of periorbital volume are required. We reviewed 12 patients with hypoplastic orbital deformities, who have undergone orbital osteotomy and free flap transfer. Reconstruction of the orbital cavity was achieved using 'C' osteotomy of the lateral portion of the orbit in mild and moderate cases or transverse 'U' osteotomy of lateral wall, roof, and floor by intra-cranial approach in severe cases. Socket reconstruction and periorbital volume restoration was achieved using dorsalis pedis free flap transfer. From our experience the combination of orbital osteotomy and free flap transfer could meet the multi-requirements for the anophthalmic orbital reconstruction, including both orbital bony enlargement and soft tissue restoration.

Restoration of Thumb Abduction Damaged by Electrical Burn Using the Free Dorsalis Pedis Flap with the Extensor Hallucis Brevis Tendon

The treatment of electrical burn injuries in the hand is difficult and challenging because the burn widely and deeply damages not only the skin and subcutaneous tissue, but also tendon, muscle, ligaments, and bone. Compound defects of the skin and abductor pollicis brevis tendon caused by an electrical injury were reconstructed using a free dorsalis pedis flap including the extensor hallucis brevis tendon. This composite flap is also applicable for reconstruction of thumb abduction, although its usefulness has been reported for reconstruction of defects of the dorsal skin of the hand including the extensor tendons.

Reconstruction of the Anophthalmic Orbit by Orbital Osteotomy and Free Flap Transfer

It is a challenging problem for the plastic surgeon to perform adequate reconstruction of the postenucleation and radiated orbit of patient with retinoblastoma. Rebuilding of the orbital structure, reconstruction of the eye socket, and restoration of periorbital volume are required in this kind of orbital reconstruction. In this study, we reviewed 12 patients with hypoplastic orbital deformities who underwent orbital osteotomy and free flap transfer. Reconstruction of the orbital cavity was achieved using "C" osteotomy of the lateral portion of the orbit in mild and moderate cases or transverse "U" osteotomy of the lateral wall, roof, and floor by an intracranial approach in a portion of severe cases. Socket reconstruction and periorbital volume restoration was achieved using dorsalis pedis free flap transfer by microsurgery. What we concluded from our experience was that the combination of orbital osteotomy and free flap transfer could meet the multirequirements for anophthalmic orbital reconstruction, including both orbital bony enlargement and soft tissue restoration.

Compound grafting of dorsalis pedis flap and second toe to repair complicated hand injury

目的 探讨手部严重毁损伤所致的多指缺失、皮肤缺损的复杂手外伤的修复方法.方法对13例多指缺失、手部皮肤缺损的复杂手外伤行游离足背皮瓣与第二足趾复合及组合移植进行修复与再造.结果13例足背皮瓣与再造手指全部成活,外形满意,功能良好.结论本术式由于足背皮瓣与第二足趾共用血管蒂,切取方便,皮瓣较薄,外形好,适合于修复复杂手外伤。

Total Eyelid Reconstruction with Free Dorsalis Pedis Flap after Deep Facial Burn

Total Eyelid Reconstruction with Free Dorsalis Pedis Flap after Deep Facial Burn

Description of New Composite Tissue Transfer for Salvage of a Complex Hand Defect

Leiomyosarcoma of the soft tissue involving bones is an extremely rare tumor. In the past, a hand tumor of this type required amputation. Presently, with improved chemotherapy and reconstruction, the hand and its dexterity sometimes can be saved. In this case, after chemotherapy, the authors opted for wide excision including the skin, tendons, muscles, and bones. The large defect was reconstructed with an iliac crest autograft and a dorsalis pedis free flap including tendons. Functional result was excellent in this patient. The pathologic results also were reviewed by histology, immunohistochemistry for muscle marker, and electron microscopy.

Reconstruction of a completely burned nose by a free dorsalis pedis flap

A 25-year-old female with a scarred and contracted nose following burns, because the upper limbs could not be used as donor areas, had a free dorsalis pedis flap used to reconstruct the nose 18 months post-burn. The case is reported and the literature reviewed.

Thin cutaneous flap for intra oral reconstruction: the dorsalis pedis free flap revisited.

The dorsalis pedis flap provides thin, hairless tissue for a variety of intra oral defects. Due to concerns for the donor site, reconstructive surgeons have largely overlooked this flap, despite its numerous desirable qualities. The paper focuses on the anatomy of the first dorsal metatarsal artery and techniques which insure the preservation of adequate flap vascularity. The prevention of donor site complications centers around meticulous attention to the placement of skin grafts, with a secure tie-over dressing and the use of a posterior splint. Patients are allowed to ambulate in the early postoperative period only when venous compression is provided with an ace bandage. Vigorous attention to detail on reconstructing the foot has minimized donor site complications. The dorsalis pedis flap continues to be an important method of reconstruction in our armamentarium of free tissue donor sites.

Free skin flap transfer in repairing deep electrical burns.

From November 1977 to July 1984, we successfully treated 12 of 14 cases with severe electric burns by free skin flap transfer. A free frontal-exterior femoral flap (one case), free groin flaps (two cases), free scapular flaps (three cases), and free dorsalis pedis flaps (eight cases) were transferre