The Dorsal Metatarsal Artery Perforator Flap

Abstract

Few options exist for the resurfacing of web-space and small soft tissue defects of the dorsum of the distal foot. The study examines the anatomy of the second to fourth dorsal metatarsal arteries in 16 fresh frozen cadavers to determine if the anatomy correlates to that in the hand, permitting the design of local flaps based on perforators of these vessels. A clinical case is also presented, illustrating the efficacy of such a perforator-based flap.Sixteen Asian cadaveric lower limbs were used for this study. The specimens were prepared with latex dye injection. Dissection under loupe magnification was carried out to determine the position and caliber of the cutaneous perforators from the dorsal metatarsal arteries, and the spread of the latex dye in the skin from these cutaneous perforators. One clinical case illustration of this perforator-based flap for distal foot defect resurfacing is presented.In our cadaveric study, each second to fourth dorsal metatarsal artery had between 2 and 5 cutaneous perforators with calibers of 0.5 to 0.7 mm in diameter. The most distal cutaneous perforator was present consistently, always arising between the heads of the respective metatarsals.In conclusion, the vascular anatomy of the second to fourth dorsal metatarsal arteries is similar to that in the hand, thus allowing for the design of reliable perforator-based flaps for distal foot resurfacing.

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

“…[8][9][10][11][12][13][14] Although adequate coverage can be achieved with the reversed DMtA flap, this flap has potential drawbacks because it requires the dorsalis pedis artery to be divided and usually requires additional procedures to cover the donor site. 15 Furthermore, the first DMtA may be absent or inadequate in 9.4 to 18% of the cases as part of normal anatomic variation. 14,[16][17][18] In 1997, Bharathwaj and Quaba 10 described the distally based islanded dorsal foot flap of the first webspace as a similar flap as the Quaba flap in the hand.…”

The First Dorsal Metatarsal Artery Perforator Propeller Flap

“…13 Along this course, numerous cutaneous perforators emanate from the FDMA, with the most distal such perforator consistently located between the heads of the first and second metatarsals. 7 In all cases when present, the FDMA always eventually passes dorsal to the transverse metatarsal ligament before ending in its terminal branches. 13 What is next of importance is the branching pattern found in the first web space.…”

First dorsal metatarsal artery perforator flap to cover great toe defect

“…11 For the third variation, numerous cutaneous perforators emanate from the FDMA, with the most distal perforator consistently located between the heads of the first and second metatarsals. 7 In all cases when it is present, the FDMA always eventually passes dorsal to the transverse metatarsal ligament before ending at its terminal branches. 11 The next issue of importance involves the branching pattern found in the first web space.…”

“…5,6 The reverse first dorsal metatarsal artery (FDMA) fasciocutaneous flap offered greater reach than the dorsalis pedis flap. 2,[7][8][9][10] The adipofascial version of this flap can yield a larger-sized flap and largely avoid the donor site complications associated with the dorsalis pedis flap, but this flap may need skin grafted at the recipient site. 5 The aim of this report was to describe our experience using FDMA perforator flap to cover great toe defect.…”