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 75×40 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.
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- An atlas of flaps in limb reconstruction.Martin Dunitz, London1995 (p. 196)
- Reconstruction digitale par transfert d'orteil.Chirurgie. 1986; 112: 710-715
- The arterial system of the first metatarsal space and its influence in toe-to-hand transfer: a report of 53 long-pedicle transfers.J Hand Surg. 2002; 27-B: 73-77
- The vessels of the first metatarsal web space.J Bone Joint Surg. 1983; 65-A: 235-238
- Vascular anatomic variations in second toe transfers.J Hand Surg. 2000; 25-A: 277-281
- Anatomic study of blood supply of the dorsum of the foot and ankle.Arthroscopy. 2006; 22: 287-290
- Arteries to the great and second toe based on three-dimensional analysis of 100 cadaveric feet.Surg Radiol Anat. 1993; 15: 187-192
- Variations of the arterial anatomy of the foot.Am J Surg. 1993; 166: 130-135
- The first metatarsal web space: its applied anatomy and usage in tracing the first dorsal metatarsal artery in thumb reconstruction.Chin J Traumatol. 2004; 7: 344-347
- Transfer of vascularized extensor tendons from the foot to the hand with a dorsalis pedis flap.Plast Reconstr Surg. 1985; 76: 421-425
- Microvascular soft tissue reconstruction of the digits.J Plast Reconstr Aesthet Surg. 2006; 59: 441-450
- Free vascularized toe joint transfer to the hand. A technique for simultaneous reconstruction of the soft tissue.J Hand Surg. 2001; 26-B: 314-320
- Salvage of ischemic digits using a lateral arm fascial flap.Plast Reconstr Surg. 2001; 107: 398-407
- Dorsalis pedis flap with vascularized extensor tendons for dorsal hand reconstruction.Plast Reconstr Surg. 1993; 92: 1326-1330
- Extensor digitorum brevis free flap: anatomic study and further clinical applications.Plast Reconstr Surg. 2000; 105: 1347-1356
- The venous flaps: an experimental study of the microvascular architecture, the area of perfusion and their correlation.Br J Plast Surg. 2002; 55: 340-350
- Dorsalis pedis tendocutaneous delayed arterialized venous flap in hand reconstruction.Plast Reconstr Surg. 1999; 104: 2138-2144
- Composite palmaris longus-venous flap for simultaneous reconstruction of extensor tendon and dorsal surface defects of the hand. Long-term functional result.J Trauma. 2004; 56: 1118-1122
- A comparison of immediate and staged reconstruction of the dorsum of the hand.J Hand Surg. 1996; 21-B: 216-221
- Flap coverage of dorsum of hand associated with tendons injuries: a completely vascularized single-stage reconstruction.Microsurgery. 2003; 23: 32-39
- The vasculature and its role in the damaged and healing tendon.Arthritis Res. 2002; 4: 252-260
- Comparative study of vascularized and nonvascularized tendon grafts for reconstruction of flexor tendons in zone 2: an experimental study in primates.J Hand Surg. 1989; 14-A: 55-63
Published online: April 24, 2007
Accepted: March 13, 2007
Received: September 30, 2006
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.