ABSTRACT
Five cases of chronic ulceration following skin graft resurfacing of the weight bearing
surface of the heel are presented. All were managed with debridement and coverage
with a free innervated dorsalis pedis tissue transfer. The technical refinements that
have contributed to the reliability of the flap include careful distal identification
of the first dorsal metatarsal artery (FDMA) and division of the dorsalis pedis artery
(DPA) under direct vision below the takeoff of the FDMA. Donor site morbidity has
been minimized by taking care to preserve the extensor paratenon as a bed for the
subsequent skin graft and by immobilization of the donor foot with plaster and bed
rest for 10 days. Four of the patients were followed for 2, 4, 4, and 6 years; one
was lost to follow-up. All were active with protective sensation in their flaps. No
instances of flap breakdown and no significant donor site morbidity were noted. The
dorsalis pedis innervated free tissue transfer is recommended as a reliable procedure
for resurfacing weight bearing areas of the foot when simpler methods have failed.
