A new approach to heel ulcers: dorsalis pedis neurovascular trans-interosseous island flap

Gajiwala, Kalpesh; Mehta, IM; Mahaluxmivala, S.M.; Padia, Reema

doi:10.1016/0007-1226(87)90117-2

Cited by 9 publications

(3 citation statements)

References 6 publications

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“…The DPN was seen superficial to the DPA in 16 of the 92 lower limbs specimens studied. The dorsalis pedis neurovascular transinterosseous island flap offers to be a relief for the diabetic patients with heel ulcerations where the most important requisite is replacement of skin cover with adequate sensations (Gajiwala et al, 1987). According to the studies conducted by Buckingham et al, the anterocentral portal during ankle arthroscopy touched the DPA in 90% of specimens and in one case it lacerated the nerve (Buckingham et al, 1997).…”

Section: Discussionmentioning

confidence: 97%

Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: A cadaveric study

et al. 2008

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The aim of our work was to study the relationship between deep peroneal nerve (DPN) and dorsalis pedis artery (DPA) so that the frequency of these variations can be kept in mind by the angiographers and surgeons to ensure safe surgical approach during flap surgery. Ninety-two legs in 46 cadavers were dissected to study the relationship between DPN and DPA on the dorsum of the foot. The relationship of neurovascular bundle of the dorsum of the foot was classified into four types. Type I: division of the DPN distal to the midpoint between the two malleoli (observed in 26 limbs). In Type II, the division of the DPN was midway between the two malleoli (seen in 20 limbs). Both Type I and II are further divided into two subtypes (a and b) depending upon the crossing pattern of terminal branches of the DPN over DPA. In Type III, multiple branches of DPN were noted in two limbs. In Type IV, the looping pattern of DPN around the DPA was considered and was seen in eight limbs. Awareness of possible variations in the relationship of the DPA to DPN on the dorsum of the foot is important for vascular and reconstructive surgeons. Because it might help in decreasing confusion when considering treatment options like microvascular anastomosis in reconstruction of the leg.

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Section: Discussionmentioning

confidence: 97%

Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: A cadaveric study

et al. 2008

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“…1 In this series, we successfully used this flap to cover wounds over the tendo Achillis insertion area in 11 patients. Gajiwala et al 12 found that the DPAbased flap could adequately cover a wound over the weightbearing part of the heel. However, they noted that the anterior subcutaneous route resulted in an inadequately long vascular pedicle, and they decided to short circuit the course of the pedicle by passing the flap through the interosseous membrane.…”

Section: Discussionmentioning

confidence: 99%

“…1,10 To cover a heel wound, a DPA-based flap may have to be lengthened by a graft or the whole flap may have to pass through the interosseous membrane between the tibia and fibula to short-circuit the pedicle or to enable the flap to reach the site without tension. 11,12 In this series, we have used the DPA-based flap to cover wounds over the tendo Achillis without any lengthening of the artery by using a venous graft because this technique has less need for an excursion length to the tendo Achillis insertion site. This flap has a wide arc of rotation, reliable vascularity, and can also be used as a sensory flap.…”

Section: Introductionmentioning

confidence: 99%

Dorsalis Pedis Artery-based Flap to Cover Nonhealing Wounds over the Tendo Achillis—A Case Series

Chandra

Singh

2017

Journal of Orthopaedics, Trauma and Rehabilitation

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Background/Purpose Soft tissue necrosis after the repair of a ruptured tendo Achillis is a difficult problem commonly encountered by orthopaedic surgeons. Such wounds are difficult to manage because of the tenuous blood supply and the characteristic anatomical features of the area. Flaps such as the reverse sural flap, medial plantar flap, gastrocnemius flap and free flaps cover such wounds with a good success rate. The aim of our study was to investigate the use of a dorsalis pedis artery (DPA)-based flap to cover a wound over the tendo Achillis insertion area. Methods We report a series of 11 patients in whom wounds over the tendo Achillis insertion area were covered with a DPA-based flap. Between 1995 and 2012, 11 patients (nine men and two women), who were referred to us with a nonhealing wound over the tendo Achillis because of soft tissue necrosis after the open repair of a ruptured tendon, were selected for soft tissue coverage of the wound by using a DPA-based flap. Results The average follow-up period was 2.4 years (range, 1–6 years). The mean operative time was 1.7 hours (range, 1.5–2.0 hours). At the latest follow-up examination, the flaps had survived in all patients. Conclusion A DPA-based flap is a good and relatively less complex procedure to use to cover defects over the tendo Achillis with minimum donor site morbidity.

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Microsurgical reconstruction: The weightbearing surface of the foot

1990

Microsurgery

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Microsurgical reconstruction in the weightbearing surface of the foot is discussed. Thirty-eight patients treated at the Mayo Clinic are reviewed as well as a review of the current literature, leaving 122 patients for analysis. Minor complication rates in the skin grafted muscle flaps were 18.5% and major complication rates requiring further surgery were found in 12.9%. Fasciocutaneous and cutaneous flaps had a 25% incidence of minor complications and a 26% incidence of major complications requiring further surgery. No definite conclusions can be drawn as to which flap is indeed the best, but the newer, thinner fasciocutaneous flaps with innervation seem to hold promise. Future considerations are also discussed.

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A new approach to heel ulcers: dorsalis pedis neurovascular trans-interosseous island flap

Cited by 9 publications

References 6 publications

Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: A cadaveric study

Relationship between the deep peroneal nerve and dorsalis pedis artery in the foot: A cadaveric study

Dorsalis Pedis Artery-based Flap to Cover Nonhealing Wounds over the Tendo Achillis—A Case Series

Microsurgical reconstruction: The weightbearing surface of the foot

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