The First Dorsal Metatarsal Artery Perforator Propeller Flap.

BACKGROUND: Distal foot and toe defects requiring a vascularized flap for coverage have very limited options, oftentimes justifying even a free flap. Perforator flaps in general and propeller flaps in particular have opened up an entirely new subset of local tissue transfer alternatives that can potentially avoid the difficulties that accompany microvascular tissue transfers. The first dorsal metatarsal artery (FDMA) perforator propeller flap represents another variation of this theme. METHODS: A standard FDMA flap from the dorsum of the foot was raised in reversed fashion based on the distal communicating branch or "perforator" from the plantar foot circulation in 2 patients with great toe defects. All distal skin tissue between this perforator and the defect was kept with the FDMA flap as an attached minor blade, to thereby create an FDMA propeller flap. RESULTS: Salvage of the great toe in both patients was achieved. The benefit of the minor blade of the propeller was to fill a portion of the donor site defect of the traditional FDMA major blade, to permit tension-free donor site closure of the dorsal foot without sequela. CONCLUSIONS: The distal-based FDMA flap can be useful as a local flap for coverage of distal foot and toe wounds, but direct donor site closure can be problematic as mirrored by its relative the dorsalis pedis flap. The FDMA perforator propeller flap variation can achieve the same reconstructive goals while simultaneously transferring vascularized tissue into the dorsal foot donor site to thereby minimize the tension if direct closure is possible or minimize the need for a skin graft in this notoriously difficult region.

Estudio cadaverico de la anatomia vascular de la cabeza del primer metatarsiano con osteotomia en Chevron distal con liberacion lateral o no / Cadaver study of the vascular anatomy of the first metatarsal head with distal Chevron osteotomy with or without lateral release

Introduccion: El proposito de este trabajo fue estudiar la irrigacion de la cabeza metatarsiana y sus cambios con la tecnica empleada y determinar las causas de daño vascular y el riesgo de necrosis avascular. Materiales y metodos: Se estudiaron 16 piezas cadavericas de pies de adultos, sin patologia vascular, divididos en: a) cuatro piezas formolizadas y conservadas mediante tecnicas Mar II; b) cuatro piezas canalizadas en fresco en las arterias tibial posterior, anterior y peronea, inyectadas luego con latex RV620 coloreado de rojo; c) cuatro piezas igualmente tratadas antes con osteotomia en chevron sin liberacion lateral y d) cuatro piezas igualmente tratadas antes con osteotomia en chevron con liberacion lateral. Resultados: Luego del estudio se encontro una extensa red arterial extraosea, con sitios de anastomosis entre la tibial posterior y la pedia. No se observaron grandes modificaciones en la irrigacion con la osteotomia mas liberacion lateral en comparacion con el grupo control. Se identificaron errores tecnicos en la sobrepenetracion de la hoja de sierra en la corteza lateral por no respetar las zonas de seguridad.Conclusiones: Se constato la importancia de la preservación de la vasculatura pericapsular y de la liberacion lateral minuciosa respetando las zonas de seguridad para evitar errores tecnicos. No se observaron diferencias sustanciales en el daño vascular entre las piezas con osteotomía ampliada y las piezas de control, con lo que se llego a la conclusion que la incidencia de necrosis es baja

Origins of the dorsal metatarsal arteries in humans.

The foot is indispensable for man's daily activities and the integrity of its structure depends on its irrigation. The number of bypass operations for its arteries therefore increases as well as the use of vascularised flaps to cover defects in its dorsal region. To find out more details about the irrigation of the dorsum of foot, the formation of dorsal metatarsal arteries (DMA) was examined in 50 feet of 25 fixed cadavers of Brazilian adults of both sexes. The feet arteries were injected with neoprene latex dyed red, and then dissected. The first DMA originated from the dorsalis pedis artery in 86%, from the plantar network in 10% and the origin was mixed in 4%. The second DMA originated from the arcuate artery exclusively in 10%, the third DMA in 6%, and the fourth DMA in 10%. In its absence (48%), the lateral tarsal arteries and the proximal perforating branches were responsible for the formation of the second DMA in 52%, of the third DMA in 54%, and of the fourth DMA in 72%. The proximal perforating branches made an important contribution to the formation of such arteries, contributing partially or totally to the second DMA in 90%, to the third DMA in 92%, and to the fourth DMA in 86%.