Digital artery flaps for closure of soft tissue defects of the forefoot

Reconstruction of Weightbearing Forefoot Defects with Digital Artery Flaps

“…However, these cannot provide durable coverage and often result in a dysfunctional scar, which tends to break down under the influence of the pressure and constant shearing forces of weightbearing. The dysfunctional scar is also a common etiology for reconstruction of the forefoot (1,8). Other methods described for coverage of forefoot defects have included the reversed first dorsal metatarsal artery flap (9), the reversed extensor digitorum muscle island flap (10), and the distally based sural flap (11).…”

“…However, the scar tends to breakdown under the influence of pressure and the constant shearing forces. Local random flaps have also been limited in use because of the excursion potential, and the plantar structures can be compromised by extensive dissection (1).…”

Reverse flow digital artery pedicle flap for closure of diabetic forefoot ulceration

“…Pallua et al reviewed the use of reversed island flaps in 12 diabetic patients; however, their study was restricted to dorsalis pedis flaps and medial plantar artery flaps (13). Dutch et al reported on the digital artery pedicle flap for forefoot wounds in 12 patients, but not all were diabetic (4). Roukis and Zgonis described modifications of the great toe fibular flap for soft tissue and bone reconstruction in the diabetic foot (12).…”

“…Meticulous, atraumatic dissection is critical to maintaining flap viability. Coverage of the donor site can be achieved through a STSG or syndactilization to an adjacent toe (4). In this case report, the authors harvested a STSG from the medial arch of the foot rather than from the more traditionally used leg or thigh sites.…”

“…Use of adjacent or distant soft tissue of similar properties can provide better options to restore the specialized tissue of the forefoot. Although local random flaps are associated with low morbidity, their use in the forefoot is limited by excursion potential and the plantar structures can be compromised through extensive dissection (4). Pedicled island flaps, first described by Moberg for use in the foot, provide adequate coverage with similar tissue without disturbing the existing plantar anatomy (5).…”