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

Abstract

Digital artery pedicle flap is a useful surgical technique for coverage of plantar foot defects. For diabetic forefoot ulcers that are subject to recurrence despite consistent care, this flap can provide long-term durable closure. The authors provide a case report and overview of this innovative reconstructive procedure.

Traumatic Forefoot Reconstructions With Free Perforator Flaps

“…Limited reports have been published on the use of local flaps for forefoot coverage, such as the dorsal metatarsal V-Y advancement flap, reversed island flaps, reverse first dorsal metatarsal artery flap, distally based islanded dorsal flap, dorsal pedal neurocutaneous flap, retrograde-flow medial plantar island flap, reverse flow digital artery pedicle flap, and digital fillet flap (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These flaps have the disadvantages of limited size and the requirement of a donor site, which is always impossible in traumatic foot injuries.…”

Reconstruction of the plantar toe with a distal reverse instep sensory island flap

“…Reconstructive surgeries on the plantar surface of the great toe have always been challenging because the skin of the plantar toe has a particular sensory role and is always exposed to injury. Several methods have been reported for coverage of the plantar surface of the toe, including the filleted toe flap, reverse flexor digitorum brevis muscle island flap, plantar marginal septum cutaneous flap, medial plantar flap based distally on the lateral plantar artery, medial plantar free flap, distant flap (cross-leg flap), toe digital artery perforator pedicle flap, reverse dorsalis pedis flap, and skin graft (Akhtar et al, 2014;Hayashi & Maruyama, 1993;Ishikawa, Isshiki, Suzuki, & Shimamura, 1987;Ramanujam & Zgonis, 2010;Russo, Delia, Casoli, Colonna, & Stagno d'Alcontres, 2014;Sakai, 1993;Senyuva, Yucel, Fassio, Cetinkale, & Goga, 1996;Uygur, Duman, Ulkur, Noyan, & Celikoz, 2008), but each method is limited by a lack of sensation preservation in the reconstructed region. A distal reverse instep island flap has been used (Uygur et al, 2008), but no sensory co-optation was applied.…”

“…Moberg first described the use of a pedicled island flap in the foot with similar tissue coverage (Ramanujam & Zgonis, 2010), and different studies reported that the instep region has been successfully repaired in defects of the heel, the great toe, and other parts involved in plantar foot reconstruction (Liu, Zhou, Cao, Cao, & Cai, 2014;Ramanujam & Zgonis, 2010;Siddiqi, Hafeez, Cheema, & Rashid, 2012;Uygur et al, 2008). Accordingly, distal reverse instep island flap seemed to be a suitable choice for most of the plantar first toe defects.…”