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

With great interest, I read the article by Van Alphen et al published in the Journal of Reconstructive Microsurgery in Volume 31, July 2015.[1] The authors performed a cadaveric dissection study of first to fourth dorsal metatarsal arteries to evaluate the vascular anatomy of distal perforators. In addition, the authors reported on their clinical experience with the distally based dorsal metatarsal artery perforator flap in one case. I want to share our experience, as it would supplement the findings in this article. The authors report clinical examples in the literature, however, were missing our article.[2] Six patients underwent distal foot reconstruction with seven metatarsal artery perforator (MAP)-based propeller flaps. Five flaps were based on the third metatarsal artery and two flaps were based on the first metatarsal artery. The flap size ranged from 4 × 2 cm to 8 × 4 cm. All flaps completely survived. Preoperatively, perforators on the dorsal metatarsal area were marked with the assistance of a handheld Doppler probe. Due to the perforator size being extremely tiny, flap elevation was maintained just until sufficient rotation was achieved, and no other unnecessary dissection was performed. In all our patients, we used a flap design rotated to 45 to 180 degrees to cover forefoot defects based on the “propeller” principle. Our article describes our clinical experience with both first MAP flap and the third MAP flap used to reconstruct distal foot defects, the MAP propeller flap based on the third metatarsal artery was first reported in this article.

Although MAP flap is a valuable option in distal foot reconstruction, it is still a new concept and has not reached common use in clinical practice. We think that the demonstration of its blood supply in detail with this cadaveric study will let us use MAP flap more frequently and safely now.

• References

• 1 van Alphen NA, Laungani AT, Christner JA, Lachman N, Carlsen BT, Saint-Cyr M. The distally based dorsal metatarsal artery perforator flap: vascular study and clinical implications. J Reconstr Microsurg 2016; 32 (4) 245-250
• 2 Cinpolat A, Bektas G, Ozkan O , et al. Metatarsal artery perforator-based propeller flap. Microsurgery 2014; 34 (4) 287-291