J Reconstr Microsurg 2016; 32(04): 245-250
DOI: 10.1055/s-0035-1554936
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Distally Based Dorsal Metatarsal Artery Perforator Flap: Vascular Study and Clinical Implications

Nick A. van Alphen
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Alexis T. Laungani
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Jodie A. Christner
2   Department of Radiology, Mayo Clinic, Rochester, Minnesota
,
Nirusha Lachman
3   Department of Anatomy, Mayo Clinic, Rochester, Minnesota
,
Brian T. Carlsen
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
,
Michel Saint-Cyr
1   Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

28 December 2014

28 March 2015

Publication Date:
10 July 2015 (online)

Abstract

Background Intrinsic flaps based on the dorsal metacarpal arteries are useful for coverage of dorsal hand, finger, and thumb defects. The purpose of this study was to explore the anatomy of the dorsal metatarsal arteries (DMtAs) in the foot to help define their clinical utility. We observed the size and numbers of distal perforators from the DMtAs and quantified the vascular perfusion pattern of the DMtA perforator across the skin.

Methods Ten fresh cadaver feet were injected with latex and dissected to assess the size and number of distal perforators from the DMtAs. Five DMtA perforator flaps were injected with methylene blue to visualize and quantify the vascular territory of the skin flap to understand the clinical possibilities. In addition, a clinical case is described and shown.

Results Ten fresh cadaver feet were dissected. The first DMtA was absent in two specimens and the second, third, or fourth DMtA was absent in one specimen each. The available DMtAs had between two and five cutaneous perforators supplying the skin (average, 3.7 perforators per DMtA). The largest perforators to the skin were always seen in the distal half of the DMtA and ranged from 0.4 to 0.8 mm (average, 0.5 mm). Methylene blue injections showed an average flap surface of 21.6 × 47.6 mm.

Conclusion This cadaveric study demonstrates the usefulness of the DMtA perforator flap. The flap is a valuable addition to the arsenal of flaps to cover the dorsum of the toe, webspace, or defects exposing tendons on the distal dorsum of the foot.

 
  • References

  • 1 Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg 1990; 43 (1) 28-39
  • 2 Bailey SH, Andry D, Saint-Cyr M. The dorsal metacarpal artery perforator flap: a case report utilizing a quaba flap harvested from a previously skin-grafted area for dorsal 5th digit coverage. Hand (NY) 2010; 5 (3) 322-325
  • 3 Attinger C. Soft-tissue coverage for lower-extremity trauma. Orthop Clin North Am 1995; 26 (2) 295-334
  • 4 Attinger C. Use of skin grafting in the foot. J Am Podiatr Med Assoc 1995; 85 (1) 49-56
  • 5 Attinger CE, Bulan E, Blume PA. Surgical débridement. The key to successful wound healing and reconstruction. Clin Podiatr Med Surg 2000; 17 (4) 599-630
  • 6 Myerson M. Soft Tissue Trauma: Acute and Chronic Management. 7th ed. St. Louis: Mosby; 1999
  • 7 Serletti JM, Moran SL. Soft tissue coverage options for dorsal foot wounds. Foot Ankle Clin 2001; 6 (4) 839-851
  • 8 Balakrishnan C, Chang YJ, Balakrishnan A, Careaga D. Reversed dorsal metatarsal artery flap for reconstruction of a soft tissue defect of the big toe. Can J Plast Surg 2009; 17 (3) e11-e12
  • 9 Koul AR, Patil RK, Philip VK. Coverage of defects over toes with distally based local flaps: A report of four cases. Indian J Plast Surg 2008; 41 (1) 62-66
  • 10 Bharathwaj VS, Quaba AA. The distally based islanded dorsal foot flap. Br J Plast Surg 1997; 50 (4) 284-287
  • 11 Earley MJ, Milner RH. A distally based first web flap in the foot. Br J Plast Surg 1989; 42 (5) 507-511
  • 12 Hayashi A, Maruyama Y. Reverse first dorsal metatarsal artery flap for reconstruction of the distal foot. Ann Plast Surg 1993; 31 (2) 117-122
  • 13 Cheng MH, Ulusal BG, Wei FC. Reverse first dorsal metatarsal artery flap for reconstruction of traumatic defects of dorsal great toe. J Trauma 2006; 60 (5) 1138-1141
  • 14 Governa M, Barisoni D. Distally based dorsalis pedis island flap for a distal lateral electric burn of the big toe. Burns 1996; 22 (8) 641-643
  • 15 Yeo CJ, Sebastin SJ, Ho SY, Tay SC, Puhaindran ME, Lim AY. The Dorsal Metatarsal Artery Perforator Flap. Ann Plast Surg 2014; 73 (4) 441-444
  • 16 Man D, Acland RD. The microarterial anatomy of the dorsalis pedis flap and its clinical applications. Plast Reconstr Surg 1980; 65 (4) 419-423
  • 17 May Jr JW, Chait LA, Cohen BE, O'Brien BM. Free neurovascular flap from the first web of the foot in hand reconstruction. J Hand Surg Am 1977; 2 (5) 387-393
  • 18 Lippert H. Variability of hand and foot arteries [in German]. Handchir Mikrochir Plast Chir 1984; 16 (4) 254-258
  • 19 Hallock GG. A paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps. J Reconstr Microsurg 2013; 29 (4) 233-240
  • 20 Huber J. The arterial network supplying the dorsum of the foot. Anat Rec 1941; 80 (3) 373-391
  • 21 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124 (5) 1529-1544
  • 22 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Combined submental flap with toe web for reconstruction of the lip with oral commissure. Br J Plast Surg 2000; 53 (7) 616-619
  • 23 Koshima I, Okumoto K, Umeda N, Moriguchi T, Ishii R, Nakayama Y. Free vascularized deep peroneal nerve grafts. J Reconstr Microsurg 1996; 12 (3) 131-141