Metatarsal Artery Research Articles

Complications following tarsal arthrodesis using bone plate fixation in dogs

To report the complications encountered following tarsal arthrodesis surgery with bone plate fixation and describe the previously unreported complication of plantar necrosis. Medical records of 40 dogs that had been treated by tarsal arthrodesis with bone plate fixation were reviewed to determine the major and minor complications and the associated risk factors. The major complication rate was 32.5 per cent and the minor complication rate was 42.5 per cent. Pantarsal arthrodeses had a higher major complication rate than partial tarsal arthrodeses. Plantar necrosis was the most common major complication and occurred in 15 per cent of cases. Plantar necrosis occurred more frequently when a bone plate was applied to the medial aspect of the hock, and only occurred in cases where tarsometatarsal joint arthrodesis was performed. Plantar necrosis is a catastrophic complication that may be associated with injury to the dorsal pedal artery or perforating metatarsal artery. Application of a bone plate to the medial aspect of the hock should be performed with care during tarsal arthrodesis, particularly where the tarsometatarsal joint is debrided of cartilage. Strict attention to surgical technique and proper postoperative coaptation is critical to reduce the potential for complications with tarsal arthrodesis.

MR angiography of the pedal arteries with gadobenate dimeglumine, a contrast agent with increased relaxivity, and comparison with selective intraarterial DSA

To compare gadobenate dimeglumine (Gd-BOPTA)-enhanced MR angiography (i.e., contrast-enhanced MRA [CE-MRA]) of the pedal vasculature with selective digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease (PAOD). A total of 22 patients with PAOD were prospectively examined at 1.5T. For contrast enhancement, 0.1 mmol/kg body weight of Gd-BOPTA were applied. MRA consisted of dynamic imaging with acquisition of six consecutive data sets. Acquisition time for each data set was 24 seconds, voxel size was 1.0 x 1.0 x 1.3 mm(3). A total of 20 out of 22 patient underwent selective DSA, two patients fine-needle DSA. DSA and MRA were performed within seven days. Image analysis was independently done by two observers with assessment of overall image quality, motion artifacts, detection of patent vessel segments of the distal calf and pedal vessels, and the number of patent metatarsal arteries. After four weeks, a consensus reading of DSA images was done. A second consensus reading of CE-MRA was performed after a further six weeks. Consensus readings of MRA and DSA revealed higher image quality and fewer motion artifacts for MRA (P = 0.021 and P = 0.008, respectively, sign test); interobserver agreement was good (kappa = 0.78) for image quality, and moderate (kappa = 0.46) for motion artifacts. There were no differences between CE-MRA and DSA in detecting patent vessel segments with a high degree of agreement (kappa = 0.89), and interobserver agreement for MRA was substantial (kappa = 0.89). Significantly more vessels were assessed as partially occluded on DSA than on CE-MRA (P = 0.004). There was a good agreement between DSA and CE-MRA for assessment of relevant vessel stenosis (kappa = 0.61); interobserver agreement for MRA was good (kappa = 0.65). CE-MRA detected significantly more patent metatarsal arteries than did DSA (P < 0.001). Gd-BOPTA-enhanced MRA is comparable to DSA for assessment of the pedal vasculature, and is able to delineate significantly more patent vessels without segmental occlusions and more metatarsal arteries than selective DSA.

True aneurysm of a metatarsal artery

True aneurysm of a metatarsal artery

Blood Supply to the First Metatarsal Head and Vessels at Risk with a Chevron Osteotomy

Chevron osteotomy, a commonly performed procedure for the treatment of hallux valgus, results in osteonecrosis of the first metatarsal head in 0% to 20% of cases. The aim of this study was to map out the arrangement of the vascular supply to the first metatarsal head and its relationship to the limbs of the chevron osteotomy. Ten cadaveric lower limbs were injected with an India ink-latex mixture, and the feet were dissected to assess the blood supply to the first metatarsal head. The dissection was carried out by tracing the branches of the dorsalis pedis and posterior tibial vessels. A distal chevron osteotomy was mapped, with the limbs of the osteotomy set at an angle of 60 degrees from the geometric center of the first metatarsal head. The relationship of the limbs of the osteotomy to the blood vessels was recorded. The first metatarsal head was found to be supplied by branches from the first dorsal metatarsal, first plantar metatarsal, and medial plantar arteries. The first dorsal metatarsal artery was the dominant vessel among the three arteries in eight specimens. All of the vessels formed a plexus at the plantar-lateral aspect of the metatarsal neck, just proximal to the capsular attachment, with a varying number of branches from the plexus then entering the metatarsal head. The plantar limb of the proposed chevron cuts exited through this plexus of vessels in all specimens. Contrary to the widely held view, only minor vascular branches could be found entering the dorsal aspect of the neck. The identification of the plantar-lateral corner of the metatarsal neck as the major site of vascular ingress into the first metatarsal head suggests that constructing the chevron osteotomy with a long plantar limb exiting well proximal to the capsular attachment may decrease the postoperative prevalence of osteonecrosis of the first metatarsal head.

Repairing the coexistent bare-phalange traumas of the first two toes by the reversed island flaps pedicled with the first dorsal metatarsal artery

Repairing the coexistent bare-phalange traumas of the first two toes by the reversed island flaps pedicled with the first dorsal metatarsal artery

Anatomical bases of the second toe composite dorsal flap for simultaneous skin defect coverage and tendinous reconstruction of the dorsal aspect of the fingers

Coverage of the dorsal aspect of the fingers is difficult, especially when the soft tissue defect is large and involves extensor apparatus and joints. Tendinous and/or articular reconstruction is not usually performed simultaneously with cutaneous repair. The aims of this study were: (1) to accurately determine the precise position of the first common dorsal metatarsal artery (FDMA) on the dorsal aspect of the foot, and (2) to enumerate the anatomical structures which could be harvested 'en-bloc' in order to design composite flaps. The precise position of the FDMA was studied from 22 anatomical specimens after selective injection of the arterial network. Its cutaneous area measured 75 x 40 mm on average. The extensor apparatus of the second toe was supplied by the FDMA and its lateral branch to the second toe by 2.7 branches on average over a length of approximately 75 mm. The medial dorsal digital artery was generally the main source of blood supply to the proximal interphalangeal joint (PIP), capsule, ligaments, head of proximal phalanx and base of middle phalanx. It is then possible to design composite flaps including both skin and extensor apparatus, and total or partial PIP joint, if necessary, based on the FDMA and the medial dorsal digital artery, without prejudice to the second toe. The average length of the arterial pedicle (60 mm) makes its suture to the dorsal metacarpal artery, the dorsal carpal branch or the radial artery easy. The harvesting technique for such a flap is described for each anatomical type of FDMA; it has to be adapted to both the type and extent of the defect. Its use is in accordance with the modern classical principle of 'all in one stage with early mobilisation', thanks to adequate coverage whose blood supply does not depend on local vascularisation, and which brings its own physiological vascular supply.

Vascular Anatomy of Plantar Muscles

Many reports on the plantar arteries and the deep plantar arch exist, but none of them focus on the arterial pedicles of the plantar muscles. They mainly discuss the deep plantar arch, its variations, and location. This study plans to determine the location and origin of arterial pedicles of all the plantar muscles as a preliminary study for designing new flaps. The study was carried out on 20 feet from 10 cadavers aged from 35 to 67 years. After an injection of latex via popliteal arteries, dissection of the arteries was carried out under a microscope. Abductor hallucis and flexor hallucis brevis muscles receive their main blood supply from the medial plantar artery; abductor digiti minimi and flexor digiti minimi brevis muscles receive their main blood supply from the lateral plantar artery. The flexor digitorum brevis muscle receives branches from both arteries. Adductor hallucis and plantar interosseous muscles receive branches from plantar metatarsal arteries. Quadratus plantae is directly nourished from a branch of the posterior tibial artery. No distal anastomoses between the medial and lateral plantar arteries were identified, except 1 specimen in which the medial plantar artery made anastomosis with the deep plantar arch. As a result, the arterial pedicles of all the plantar muscles were defined, and based on these findings, new flaps can be planned or existing flaps can be modified.

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.

Temporary Arteriovenous Loop Between the Saphenous Vein and the First Plantar Metatarsal Artery in Toe-to-Hand Transfers

We describe a technique for creating a temporary arteriovenous loop by anastomosing the saphenous vein to the first plantar metatarsal artery to facilitate harvesting and subsequent anastomosis of a great or second toe transfer. This technique has been used in 9 patients: 6 pediatric toe-to-hand transfers for congenital hand differences and 3 adult toe transfers for a thumb amputation. All 9 toe transfers survived. The advantages of this technique are that it allows precise determination of the exact length of the loop to reach the recipient artery, it facilitates palmar positioning of the arterial pedicle, and, if necessary, the saphenous vein can be anastomosed directly to the lateral digital artery of a great toe transfer or the medial digital artery of a second toe transfer rather than the first plantar metatarsal artery itself, thereby minimizing more proximal dissection of the first plantar metatarsal artery, which is more difficult and time consuming.

An anatomical study and clinical application of free transfer of foot tissues pedicled with plantar metatarsal artery

目的 寻求一种更为安全、有效的足部组织游离移植再造拇、手指及关节功能的新方法,进一步提高手术成功率.方法 对足部跖底与跖背动脉系统进行显微解剖学研究.设计并应用逆行游离、吻合跖底动脉的足部组织游离移植术治疗76例拇、手指及手部关节缺损患者,其中第二足趾移植58例,第二足趾复合组织移植4例,近侧趾间关节移植8例,(足母)甲瓣移植6例.分析总结其疗效.结果 第一跖底动脉解剖恒定,到第二足趾的分支粗于第一跖背动脉.75例患者全部成活,移植部位外观良好,功能明显改进,总成活率为98.7%.另1例行第二足趾游离移植再造拇指术患者因顽固性动脉痉挛而改用锁骨下皮管包埋.结论 应用逆行游离跖底动脉为蒂的足部组织游离移植术可以克服其它方法存在的血管解剖变异较大、操作复杂、费时等不足,提高了手术效率和成功率。

The effect of hypovolemia due to hemorrhage on the minimum alveolar concentration of isoflurane in the dog

ObjectiveTo determine the effect of hypovolemia on the minimum alveolar concentration (MAC) of isoflurane in the dog. Study designRandomized, cross-over trial. Animal populationSix healthy intact mixed breed female dogs weighing 18.2–29.0 kg. MethodsDogs were randomly assigned to determine the MAC of isoflurane in a normovolemic or hypovolemic state with a minimum of 18 days between trials. On both occasions, anesthesia was initially induced and maintained for 40 minutes with isoflurane delivered in oxygen while vascular catheters were placed in the cephalic vein and dorsal metatarsal artery. In dogs assigned to the hypovolemic group, 30 mL kg−1 of blood was removed at 1 mL kg−1 minute−1 from the arterial catheter. All dogs were allowed to recover from anesthesia. Thirty minutes after the discontinuation of isoflurane, anesthesia was re-induced with isoflurane in oxygen delivered by face mask. The tracheas were intubated, and connected to an anesthetic machine with a Bain anesthetic circuit. Mechanical ventilation was instituted at a rate of 10 breaths minute−1 with the tidal volume set to deliver 10–15 mL kg−1. Airway gases were monitored continuously and tidal volume was adjusted to maintain an end-tidal carbon dioxide level of 35–40 mmHg (4.67–5.33 kPa). Body temperature was maintained at 37–38 °C (98.6–100.4 °F). The MAC determination was performed using an electrical stimulus applied to the toe web and MAC was defined as the mean value of end-tidal isoflurane between the concentrations at which a purposeful movement did and did not occur in response to the electrical stimulus. The MAC values were compared between groups using a Student's t-test. ResultsThe MAC of isoflurane was significantly less in hypovolemic dogs (0.97 ± 0.03%) compared with normovolemic dogs (1.15 ± 0.02%) (p < 0.0079). Conclusions and clinical relevanceThe MAC of isoflurane is reduced in dogs with hypovolemia resulting from hemorrhage. Veterinarians should be prepared to deliver a lower percentage of isoflurane to maintain anesthesia in hypovolemic dogs during diagnostic and therapeutic procedures.

Vascularized Bone Blocks From the Toe Phalanx to Solve Complex Intercalated Defects in the Fingers

Vascularized bone transplants resist infection and allow rapid healing but keeping small bony segments vascularized, as needed for a finger defect, is a challenge. The purpose of this article is to present a cohort of patients with traumatic intercalated compound bony defects in the fingers that were reconstructed by a vascularized toe phalanx (or part of a phalanx) in a single stage. Eight patients were treated with an intercalary vascularized bone graft that included a part of the proximal phalanx (3 patients), most of the middle phalanx (4 patients), or a portion of each phalanx (1 patient) of a second toe (totaling 9 bone blocks). There was an associated soft-tissue defect in each patient, an infection in 6 patients, and cartilage loss in 4 patients. The toes were pedicled on the proper digital artery (6 patients) or a segment of the first dorsal metatarsal artery (2 patients). A mean length of 12 mm of vascularized bone was transferred. The associated skin island varied from a minimum of 2 x 1 cm to a maximum of 5 x 3 cm. Bleeding from all of the bone surfaces was evidenced once the clamps were released. The homolateral digital nerve and the contralateral neurovascular pedicle of the toe were kept in place. The toe defect was treated by soft-tissue arthroplasty or arthrodesis. No toe was amputated. Radiologic bony union was evident at 4 to 6 weeks, except in 1 patient with an acute infection whose distal union failed to unite at 6 weeks because the infection recurred. Finger length loss averaged 3 mm. All patients returned to their preoperative occupation. In this group of patients the toe phalanx reliably maintained its vascularization, allowing us to solve compound osteocutaneous defects in the fingers in a single stage. Donor site morbidity was minimal.

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.

Development of baroreflex function and hind limb vascular reactivity in the horse fetus

This study investigated, in vivo, the mechanisms underlying the development of cardiovascular function in the horse fetus, with particular relevance to baroreflex function and hind limb vascular arterial reactivity to constrictor agonists. Under general anaesthesia, vascular catheters were inserted and a Transonic flow probe was implanted around one of the metatarsal arteries of 13 horse fetuses, either at 0.6 of gestation (n= 6) or at 0.9 of gestation (n= 7, term approximately 335 days). At least 5 days after surgery, pressor, vasoconstrictor and cardiac chronotropic responses to exogenous bolus doses of phenylephrine, angiotensin II and arginine vasopressin were recorded. Fetal cardiac baroreflex slopes were obtained using the peak pressor and heart rate responses to increasing doses of phenylephrine. Fetal treatment with phenylephrine, angiotensin II and vasopressin produced significant changes in arterial blood pressure, hind limb vascular resistance and heart rate. Pressor and vasopressor responses to all agonists were greater at 0.9 than at 0.6 of gestation; however, fetal cardiac baroreflex sensitivity decreased with advancing gestational age. Correlation analysis revealed that fetal plasma cortisol rather than gestational age was a greater determinant of pressor and vasopressor reactivity. In contrast, gestational age rather than cortisol better determined heart rate and baroreflex responsiveness in the equine fetus. The data show that development of cardiovascular function in the equine fetus occurs via cortisol-dependent and -independent pathways.

Clinical significance of classification of vascularity at toe web in toe transfer

目的 分析120例足趾移植再造手指病例,对趾蹼间的血管形态和交通情况进行观察,并阐述其临床意义.方法临床观察120例156侧趾蹼,对第一跖骨背动脉和第一趾底动脉在趾蹼间的走向、口径以及两者的交通支情况进行记录并进行分型.结果按孙博的分型方法[1]:Ⅰ型72侧,占46.2%;Ⅱ型57侧,占36.5%;Ⅲ型7侧,占4.5%;Ⅳ型3侧,占1.9%;Ⅴ型15侧,占9.6%;另有2侧(占1.3%)第一跖骨背血管口径>1mm,虽发出趾背动脉供养趾胫侧和第二趾腓侧,但在趾蹼内与趾底血管无吻合,故称之为孙博Ⅵ型.结论 (1) 从解剖形态看应增加孙博Ⅵ型较全面;(2) 从临床实用角度出发,趾蹼间血管可以简单分为三型:Ⅰ型交通支口径在0.5mm以上.Ⅱ型交通支在0.5mm以下.Ⅲ型无交通;(3) 手术中采用第一套或第二套供血系统,首先要看趾蹼间血管的交通支,即按本组的分型属Ⅰ型采用第一套供血系统,Ⅱ、Ⅲ型采用第二套供血系统。

Original investigation of right-to-left shunting patent ductus arteriosus in an Irish setter puppy

A six-month-old, entire female, Irish setter was presented with a two-month history of progressive hindlimb weakness and collapse on exercise. Thoracic auscultation revealed a soft systolic murmur and a split second heart sound. Differential cyanosis and polycythaemia were not observed. Right-to-left shunting patent ductus arteriosus (r-PDA) was confirmed on contrast echocardiography (“bubble study”) and selective right ventricular angiography. Comparison of blood gases from the metatarsal and auricular artery confirmed the presence of differential hypoxia. This technique is not known to have been described previously in the diagnostic investigation of r-PDA in dogs.

Sonography of the first dorsal metatarsal artery of the foot

To describe the gray-scale and Doppler sonographic examination technique and appearances of the first dorsal metatarsal artery (FDMA) of the foot and discuss its clinical significance. The dorsal arteries of foot-including the FDMA and the first plantar metatarsal artery-of 374 feet were studied using gray-scale and color Doppler sonography. Due to the difficulty of detecting the FDMA, a majority of them were identified by studying the web area just distal to the intermetatarsal space. The interosseous muscle was identified to determine the classification of the anatomic type of the FDMA. The sonographic results of 152 feet were compared with surgical findings. The average caliber of the FDMA was 1.0 +/- 0.5 mm. The FDMA was classified into 3 groups of variants based on its relationship with the first dorsal interosseous muscle. The groups were identified as the superficial artery (54.5%), intramuscular artery (39.6%), and submuscular artery (9%) variants. The rates of visualization of the distal and proximal portions of the FDMA were 86.6% and 47%, respectively. In the first intermetatarsal space, there were anastomoses between the FDMA and the first plantar metatarsal arteries in 87.6% of the feet. The FDMA varies greatly; however, sonography can clearly show its morphologic characteristics, such as caliber and location. Sonography also provides valuable preoperative information in microsurgery of the foot.

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.

Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle

The abductor hallucis muscle flap is commonly used as a proximally-based flap in the management of ankle, heel, and midfoot lesions, where it is ideally suited for closing defects. This study investigates the anatomical details of this muscle in 13 fresh male cadavers. The medial plantar artery (MPA) was studied by dissection and macroscopic analyses to document the relationship of its superficial and deep branches with respect to the abductor hallucis muscle (AHM). Three main patterns could be described. In Pattern A (54%) the MPA divides into two branches. The deep branch reaches the deep surface of the AHM, supplying its proximal part, and the superficial branch courses between the AHM and the flexor digitorum brevis, to end as the first plantar metatarsal artery. The latter supplies two to three small branches to the distal part of the AHM. The fibers of the AHM end symmetrically on the two sides of the tendon and the muscle presents an arciform shape. The MPA, in Pattern B (38%), lacks a deep branch and continues along the lateral border of the AHM as a superficial branch that supplies proximal and distal collaterals to the muscle. The muscle fibers of the AHM end mainly on the medial side of the tendon. The muscle belly presents an arciform shape and is located on the medial margin of the foot superomedially with respect to Pattern A. In Pattern C (8%) the MPA continues as a large deep branch on the deep surface of the AHM and ends as the medial collateral artery of the big toe. A smaller superficial branch of the MPA provides a few collaterals to the AHM from its proximal part and to the flexor digitorum brevis in its distal part. The AHM fibers end mainly on the lateral side of the tendon and morphologically the muscle presents a straight line on the sole of the foot compared to Pattern A. Although Patterns B and C, from a surgical point of view, necessitate interruption of the main trunk of the MPA, Pattern A may permit the vascularization of the muscles of the medial side of the sole of the foot by the superficial trunk of the MPA. Because preoperative radiological study of the plantar vessels correlate with the morphological characteristics of the AHM observed during surgery, such imaging may be useful in determining the appropriate flap design based on the patient's unique pattern of MPA branching.

Accuracy of Indirect Measurement of Blood Pressure in Neonatal Foals

The objectives of this study were to assess, in anesthetized neonatal foals, the accuracy of 2 automated indirect oscillometric monitors for measurement of mean arterial pressure (MAP), to determine the optimal site of cuff placement for MAP monitoring, and to determine the relationship between arterial blood pressure and cardiac output. Ten neonatal foals were anesthetized and instrumented with a catheter in the metatarsal artery for direct MAP monitoring and measurement of cardiac output by lithium dilution. Concurrent MAP measurements were obtained with Cardell and Dinamap oscillometric monitors with cuffs placed at 3 different sites (coccygeal, metatarsal, and median arteries). Blood pressure was manipulated by varying the depth of anesthesia and by administration of dobutamine or phenylephrine. A statistically significant (P = .025) interaction was found between the type of monitor and cuff placement site. With the Cardell monitor, placement of the cuff over the coccygeal artery resulted in a significantly lower bias than placement over the median or dorsal metatarsal artery (P < .0001 and P = .0149, respectively). No significant difference in bias was found with cuff placement site when using the Dinamap monitor. The correlation coefficient (r) between MAP and cardiac output was 0.47. Indirect oscillometry with a cuff placed over the coccygeal artery or dorsal metatarsal artery is an acceptable method for measuring MAP in foals. Blood pressure does not correlate well with cardiac output in anesthetized foals.