Metatarsal Artery Research Articles

Anatomic variations of the dorsalis pedis artery: A cadaveric study

The dorsalis pedis artery (DPA), along with its variable branching pattern, was examined in cadaver feet. The occurrence and anatomical relationships of the DPA and its branches is of importance to clinical health care professionals for the vital role it plays in many diagnostic and corrective procedures. The DPA, a direct continuation of the anterior tibial artery, provides a lateral tarsal, a media tarsal and an arcuate branch before terminating in the 1st interosseous space by giving rise to the plantar and the dorsal metatarsal arteries.In this study, the DPA was present in all 18 feet examined as a continuation of the anterior tibial artery. Its first branch, the lateral tarsal, was noted in 94% of the cadaveric feet and originated an average of 22 mm distal to the origin of the DPA. The medial tarsal was found in 89% of the feet and originated an average of 49 mm to the origin of the DPA. The arcuate artery was the most variable branch, being present in 9 of the 18 feet examined. The two terminal arteries (first dorsal metatarsal and deep plantar) were present 94% and 89% of the time. In summary, the arcuate artery was the most variable of those studied, and the lateral tarsal artery was the most consistent branch of the DPA.

Anatomical review of dorsalis pedis artery flap for the oral cavity reconstruction

The dorsalis pedis artery (DPA) was renamed from the anterior tibialis artery after it passed under the extensor retinaculum, a nd DPA travels between the extensor hallucis longus and extensor digitorum longus muscle along the dorsum of the foot. After giving off the proximal a nd distal tarsal, arcuate and medial tarsal branches, DPA enters the proximal first intermetatarsal space via the first dorsal metatarsal artery (FDMA), which courses over the first dorsal interosseous muscle (FDIM). For detailed knowledge of the neurovascular anatomy of a dorsalis pedis artery flap (DPAF) as a routine reconstructive procedur e after the resection of oral malignant tumors, the precise neurovascular anatomy of DPAF must be studied along the DPA courses as above. In this first review article in the Korean language, the anatomical basis of DPAF is summarized and discussed after a delicate investigation of more than 35 recent articles and atlas textbooks. Many advantages of DPAF, such as a consistent flap vascular anatomy, acceptable do nor site morbidity, and the ability to perform simultaneous flap harvest using oral cancer ablation procedures, and additional important risks with the pitfalls of DPAF were emphasized. This article will be helpful, particularly for young doctors during the special curriculum periods for the Korean National Boar d of Specialists in the field of oral and maxillofacial surgery, plastic surgery, otolaryngology, orthopedic surgery, etc.

Effects of isoflurane anesthesia on cerebrovascular autoregulation in horses

To test a hypothesis predicting that isoflurane would interfere with cerebrovascular autoregulation in horses and to evaluate whether increased mean arterial blood pressure (MAP) would increase cerebral blood flow and intracranial pressure (ICP) during isoflurane anesthesia. 6 healthy adult horses. Horses were anesthetized with isoflurane at a constant end-tidal concentration sufficient to maintain MAP at 60 mm Hg. The facial, carotid, and dorsal metatarsal arteries were catheterized for blood sample collection and pressure measurements. A sub-arachnoid transducer was used to measure ICP Fluorescent microspheres were injected through a left ventricular catheter during MAP conditions of 60 mm Hg, and blood samples were collected. This process was repeated with different-colored microspheres at the same isoflurane concentration during MAP conditions of 80 and 100 mm Hg achieved with IV administration of dobutamine. Central nervous system tissue samples were obtained after euthanasia to quantify fluorescence and calculate blood flow. Increased MAP did not increase ICP or blood flow in any of the brain tissues examined. However, values for blood flow were low for all tested brain regions except the pons and cerebellum. Spinal cord blood flow was significantly decreased at the highest MAP. Results suggested that healthy horses autoregulate blood flow in the CNS at moderate to deep planes of isoflurane anesthesia. Nonetheless, relatively low blood flows in the brain and spinal cord of anesthetized horses may increase risks for hypoperfusion and neurologic injury.

The anatomy and clinical applications of the reverse medialis pedis island flap to repair of the forefoot skin detects.

Objective To explore the methods of repairing forefoot skin detects by the reverse me-dialis pedis island flap. Methods The Anostomosis, distribution and external diameters of transverse artery of great too between with the branches of the first plantar metatarsal arteries and the deep branch of medial plantar artery were observed on 48 feet of adult cardaveric specimens. Artery angiography was performed in 5 fresh fools. Clinically, 12 cases of forefoot skin detects were repaired with the reverse medialis pedis island flap by 3 new methods. There were 11 males and 1 female. The patients ranged from 12 to 54 years old, with an average age of 32 years. Results Arterial circle under the first metatarsophalangeal joints consists of transverse artery of great too, tibial proper plantar digital artery of great toe, fibular proper plantar digital artery of great toe and the distal part of first plantar meatarsal artery. The arterial arch at the superior border of hallueal abductor and the medial branch of deep branch of medial plantar artery formed an arterial reten at abductor hallucis. Clinically, we designed 3 new methods to repair 12 cases of forefeet akin detects suc-cessfully with the reverse medialis pedis island flap. All patients were followed up, with the mean of 2 years. All flaps survived totally without diabrosis and swelling. The walking and weight-bearing were normal and the blood supply of foot was good. Conclusion The reverse point of the reverse medialis pedis flapis moved forward to the proximal phalanx, resulting in longer vessel pedieles and increasing the flexibility of clinical application. The skin flap thus formed is ideal for repair forefoot skin detects. Key words: Surgical flaps; Foot injuries; Treatment outcome

Composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects

Objective To introduce the clinical application of composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects. Methods This method was applied to treat 7 cases and 19 fingers. All the cases involved complex dorsal soft tissue defect of 2 to 4 fingers with extensor tendons missing and phalanx or interphalangeal joint exposed. The combined soft tissue defect area was 5.0cm×1.5cm to 9.0 cm× 2.5 cm. The flaps were designed along the axis extending from the fibular and plantar margin of the great toe to the interspace between the first and second metatarsal bones. The flap was slightly larger than the dorsal finger defect combined and the shape of the flap was the same as the combined defect. The greater saphenous vein, dorsal digital veins and dorsal metatarsal or plantar metatarsal artery and nerves were included in the flap. They were sutured with dorsal digital veins, digital artery and nerves, respectively. Extensor digitorum brevis tendons and extensor digitorum longus tendons were included in the flap to reconstruct the missing tendons. Results All the flaps survived with good texture and good appearance. Two-point discrimination recovered 6 to 8 mm. Finger extension function was restored, and active finger flexion and extension recovered satisfactorily. The donor feet were with slight scar, good appearance and normal function. Conclusion Combined dorsalis pedis,toe web and great toe fibular flap including extensor digitorum brevis and extensor digitorum longus tendon is a good option to treat multi-finger dorsal complex defects. Key words: Surgical flaps; Finger injuries; Tendon injuries; Transplantation

Reverse second dorsal metatarsal artery island flap for repairing the soft tissue defect at toes

To report the application of reverse second dorsal metatarsal artery island flap for From May 2005 to September 2008, 5 cases with soft tissue repairing the soft tissue defect at toes. defects at toes were treated with reverse second dorsal metatarsal artery island flaps. The flaps size ranged from 2 cm x 3 cm to 5 cm x 6 cm. All the 5 flaps survived completely. The patients could walk 1-2 months after operation. The patients were followed up for 5-7 months with good appearance, texture and sensation of toes. The reverse second dorsal metatarsal artery island flap has a reliable blood supply and good tissue texture. It is a practical method for repairing the soft tissue defect at toes.

Arterial anatomy of the hallucal sesamoids

The aim of this study was to analyze the arterial supply of the sesamoid bones of the hallux. Twenty-two feet from adult cadavers were injected with epoxide resin or an acrylic polymer in methyl methacrylate (Acrifix) and subsequently processed by two slice plastination methods and the enzyme maceration technique. Afterwards, the arterial supply of the sesamoid bones was studied. The first plantar metatarsal artery provided a medial branch to the medial sesamoid bone. The main branch of the first plantar metatarsal artery continued its course distally along the lateral side of the lateral sesamoid and supplied it. The supplying arteries penetrated the sesamoid bones on the proximal, plantar, and distal sides. The analysis and cataloging of the microvascular anatomy of the sesamoids revealed the first plantar metatarsal artery as the main arterial source to the medial and lateral sesamoid bones. In addition, the first plantar metatarsal artery ran along the lateral plantar side of the lateral sesamoid bone, suggesting that this artery is at increased risk during soft-tissue procedures such as hallux valgus surgery.

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

Gadofosveset-enhanced MR angiography of the pedal arteries in patients with diabetes mellitus and comparison with selective intraarterial DSA

To compare gadofosveset-enhanced magnetic resonance angiography (MRA) of the pedal vasculature with selective intraarterial DSA. Eighteen patients with PAOD and type II diabetes were prospectively examined at 1.5 T. For contrast enhancement, 0.03 mmol/kg body weight gadofosveset was used. MR imaging consisted of dynamic and of high-resolution steady-state imaging. Selective digital subtraction angiography (DSA) was performed within 5 days and served as standard of reference. Image analysis was done by two observers. There were no differences between MRA and DSA regarding overall image quality. First-pass MRA detected significantly more patent vessel segments than did DSA (P<0.001, kappa=0.46). Interobserver agreement of MRA was very good with respect to the detection of patent vessel segments and the assessment of hemodynamically relevant stenoses (kappa=0.97 and 0.89, respectively). Steady-state imaging depicted significantly more patent metatarsal arteries than did dynamic imaging, and delineated inflammatory complications including osteomyelitis, soft-tissue abscesses, and fistulas related to the diabetic foot. Gadofosveset-enhanced MRA of the pedal vasculature proved to be superior to DSA. It offered a long imaging time window, and allowed for better depiction of the pedal outflow. Steady-state imaging delineated inflammatory complications associated with the diabetic foot.

The Lower-Extremity Allen Test

The Allen test is used to diagnose the relative contribution of the ulnar and radial arteries to each hand. We modified this test to investigate the relative vascular contributions to distal perfusion of the lower extremity. With the patient supine, a handheld Doppler is used to locate the first dorsal metatarsal artery. The posterior tibial artery (PT) and dorsalis pedis artery (DP) pulses are compressed. A persistent signal indicates collateral flow through the peroneal artery (PA). Sequential decompression is then used to evaluate the relative contribution of the PT and DP to distal circulation. We report a case in which angiography failed to predict reliance on the PT. In this case, performance of the lower-extremity Allen test (LEAT) led to an alternative recipient vessel choice. The LEAT is simple to perform and provides a valuable adjunct to angiographic data.

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.

The microvascular anatomy of the metatarsal bones: a plastination study

The purpose of this study was to categorize and systematize the arterial supply of the metatarsal bones and furthermore the observation of arterial lesions after frequently performed forefoot surgeries. Twenty-two cadaver feet were analyzed by two plastination methods and the enzyme maceration method. Five forefoot surgeries were performed after arterial injections. The bases of the metatarsal bones were primarily supplied by dorsal and plantar arteries. The arterial supply of the metatarsal diaphysis was given by a frequently observed nutrient artery. The first plantar metatarsal artery was the main supply of the first metatarsal head. The plantar and dorsal metatarsal arteries supplied the lesser metatarsals heads. The forefoot surgeries revealed lesions of arteries in all cases. The plastination methods were excellent methods to analyze the arterial supply. In addition arterial damage after forefoot surgeries could be analyzed with these methods.

Compound flap from the great toe and vascularized joints from the second toe for posttraumatic thumb reconstruction at the level of the proximal metacarpal bone

The purpose of this study is to describe the harvesting technique, anatomic variations, and clinical applications of a compound flap from the great toe and vascularized joint from the second toe used for thumb reconstruction. Five fresh cadaver dissections were studied, focusing attention on the dorsal or plantar vascular dominance, position of the communicating branch between the dorsal and plantar system, the Gilbert classification, and the size of the first dorsal metatarsal artery (FDMA) and first plantar metatarsal artery (FPMA) to the great toe and second toe. Five compound flaps were performed on five patients with traumatic thumb amputation at the level of proximal metacarpal bone. The patients' ages ranged from 14 to 47. Follow-up period was 11-24 months. The anatomic study showed that FPMA had larger caliber in 40% of dissections, FDMA in 40%, and had the same caliber in 20%. The Gilbert classification of FDMA was 40% class I and 60% class III. In the clinical applications, four patients achieved good functional opposition and motion of transferred joints with good pinch and grip strength. There was one flap failure, and donor-site morbidity was minimal. The compound flap offers advantages over traditional toe transfer by providing two functional joints. It can be used for amputation of the thumb at carpometacarpal joint level. Finally, the compound flap maintains growth potential in children through transfer of vascularized epiphyses. The disadvantages of this compound flap include a technically challenging harvest and a longer operative time.

Reconstruction of finger pulp defects by the second toe tibial skin flap

Objective To report the surgery procedure and treatment effect of reconstruction of finger pulp defects by the second toe tibial skin flap. Methods Seventy patients with pulp defects of 76 fingers were treated by the second toe tibial skin flap. The sizes of skin flap varied from 1.5 cm × 1.0 cm to 4.0 cm × 2.5 cm. The skin flap's feeding arteries were tibial plantar digital proper artery of the second toe in 60 fingers and first dorsal metatarsal artery in 16 fingers. Donor site defect was covered by full thickness skin graft. Results Seventy- six fingers in 70 cases all survived. Arterial crisis occurred in 4 fingers within three days postoperatively, which was reversed by surgical exploration. All cases were followed firm 5 months to 24 months with an average of 8 months. The flaps had satisfactory texture and shape. Good function recovery of the fingers was also achieved. The motion of distal interphalangeal joints ranged from 0 to 60 degrees, 2-PD reached 4 mm to 9 mm. Primary healing occurred in 71 toes; necrosis in central part of the skin graft ocourred in 5 toes, which healed through changing of dressing. Long-term follow-up revealed that the skin graft was durable. It did not disturb walking and was free of ulceration. Conclusion Second toe tibial skin flap is an ideal method to reconstruct finger pulp defects. The surgery is relatively simple with reasonable operation time. The reconstructed pulp is full with a near normal appearance. Key words: Surgical flaps; Finger injuries; Microsurgery; Treatment outcome

Vascular anatomy of the metatarsal bones and the interosseous muscles of the foot

Utilization of the metatarsal bones and interosseous muscles in foot reconstruction should be based on the vascular anatomy of the metatarsal bones and interosseous muscles. We studied the vascular anatomy of the metatarsal bones and the interosseous muscles to design a split metacarpal musculoosseous flap and dorsal interosseous muscle flap. Twenty-two feet from eleven cadavers that had been embalmed in formalin were studied. Dissection was done using a dissection microscope (x3.5), delineating meticulously the arcuate artery, dorsal metatarsal arteries and the small branches arising from the metatarsal arteries. The dorsal metatarsal arteries do not course at the midline of the interosseous muscles. The first dorsal metatarsal artery proceeds close to the first metatarsal bone in the first metatarsal space. While proceeding to the distal, it shoots out a branch that individually feeds the lateral head of the first dorsal metatarsal muscle and medial face of the second metatarsus, thereby feeding muscle and bone. Except for this branch, the first dorsal metatarsal gives off segmental and periosteal branches that individually feed the medial heads of the first dorsal metatarsal muscle and first metatarsal bone. The second, third and fourth metatarsal arteries proceed close to the third, fourth and fifth metatarsal bones in the metatarsal spaces. In these courses, the arteries give out segmental branches to both faces of the interosseous muscles and periosteal branches to the medial face of metatarsal bones. For defects or disease of the ankle bones, the metatarsal bones can be split at the medial border distally, and a split metatarsal musculoosseous flap, based proximally on the dorsal metatarsal artery, can be done. Distal intermetatarsal anastomoses between the dorsal and plantar vascular networks enables a split metatarsal musculoosseous flap based distally, including the dorsal metatarsal artery for bony defects of the proximal phalanx.

Second toe plasty using local flap transfer from the 3rd toe in second toe-to-thumb/finger transfer

Objective To introduce a new procedure for 2nd toe plasty by transferring local flap from the 3rd toe in 2nd toe-to-thumb/finger reconstruction. Methods In 26 cases of 2nd toe transfer to reconstruct the thumb or fingers,a flap from the 3rd toe based on an anastomosing branch from the 2nd dorsal metatarsal artery or the 2nd plantar metarsal artery was harvested and insetted to the fibular side of the middle phalanx of the 2nd toe to increase the circumference of the transplant. A pulp flap was also designed based on the anastomosis between the dorsal digital arteries,between the dorsal and plantar arteries.or between the plantar arteries.It was transfefred and insetted in the plantar aspect of the 2nd toe to eliminate middle stenosis.The pre-fabricated 2nd toe was transferred to reconstruct the thumb and fingers. ResultsAll 76 flaps of 38 toe transfers in the 26 cases survived.There was no compromise of the blood circulation to the 3rd toe.The appearance of the reconstructed finger was satisfying. Conclusion Transfer of local flap from the 3rd toe in 2nd toe-to-thumb/finger reconstruction can improve the appearance of the 2nd toe transplant and is thus a good procedure. Key words: Surgical flaps; Toes; Fingers; Microsurgery

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。

Medial Artery Calcification as an Indicator of Diabetic Peripheral Vascular Disease

Mönckeberg sclerosis or medial artery calcification (MAC) is a well-known phenomenon associated with diabetic and other arterial disease. However, its consequence within the foot, and specifically the first dorsal metatarsal artery, has not previously been studied. Nearly 1,000 foot x-rays were studied over a 9-month period in a busy hospital to identify the prevalence of first dorsal metatarsal artery calcification. The electronic medical notes for all the patients were reviewed to confirm which patients were known to be diabetic. The patients with positive findings were then identified and their HbA1c, creatinine, and previous foot interventions recorded. Of the population studied, 1.4% had medial artery calcification of the 1st dorsal metatarsal artery: 93% were known diabetics and 100% had impaired glucose tolerance (a glucose plasma concentration of greater than 7.8 mmol/l 2-hours post-glucose loading). Seventy-nine percent had required previous podiatric care for foot ulceration and 64% had required surgical intervention for their diabetic feet. MAC has a high positive predictive value (92.9% (95% CI 69.2 to 98.7)) for diabetes, with a good specificity (99.9% (95%CI 99.4 to 100)) and low false positive rate (0.1% (05%CI 0.0 to 0.6)). Medial artery calcification in the first dorsal metatarsal artery is characteristic of impaired glucose metabolism, and if seen on routine x-ray should be an indication for screening of the patient. It should also be considered as a foot-at-risk sign in the established diabetic due to the high incidence of foot ulceration and need for surgical intervention in this group.

Coverage of defects over toes with distally based local flaps: A report of four cases

Reconstruction of the distal foot, especially of the toe has always been a challenging problem. Various methods have been tried with variable success rates and limitations. Presented here is a series of four cases, where distally based flaps were used. Two of them were Extensor Digitorum Brevis (EDB) muscle flaps and the other two were first dorsal metatarsal artery (FDMA) based skin flaps. One in each of the two was augmented with a plantar V-Y advancement flap. All flaps survived completely without any flap- or donor site-related complications. The patients were ambulated two weeks following the reconstruction and were symptom-free after an average follow-up of thirteen months. Distal flaps based on the dorsalis pedis system provide a reliable cover for distal foot defects.

Coverage of defects over toes with distally based local flaps: A report of four cases

ABSTRACTreconstruction of the distal foot, especially of the toe has always been a challenging problem. various methods have been tried with variable success rates and limitations. presented here is a series of four cases, where distally based flaps were used. two of them were extensor digitorum brevis (edb) muscle flaps and the other two were first dorsal metatarsal artery (fdma) based skin flaps. one in each of the two was augmented with a plantar v-y advancement flap. all flaps survived completely without any flap- or donor site-related complications. the patients were ambulated two weeks following the reconstruction and were symptom-free after an average follow-up of thirteen months. distal flaps based on the dorsalis pedis system provide a reliable cover for distal foot defects.