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The Dorsal Metatarsal Artery Perforator Flap

Yeo, Chong Jin MBChB (Glasg), MRCS (Glasg), FAMS (Hand Surg)*; Sebastin, Sandeep J. MCh (Plastic), FAMS (Hand Surg); Ho, Samuel Y.M. MBBS (S’pore), MRCS (Edin), MMed (Gen Surg); Tay, Shian Chao MBBS (S’pore), FRCS (Edin & Glasg), FAMS (Hand Surg)§; Puhaindran, Mark E. MBBS (S’pore), MRCS (Edin), FAMS (Hand Surg); Lim, Aymeric Y.T. MBBS (S’pore), FRCS (Glasg), FAMS (Hand Surg)

doi: 10.1097/SAP.0b013e31827fb029
Research
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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.

From the *Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore; †Hand & Reconstructive Microsurgery Department, National University Health System, Singapore; ‡Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore; and §Department of Hand Surgery, Singapore General Hospital, Singapore, Singapore.

Received November 20, 2012, and accepted for publication, after revision, November 24, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Samuel Y.M. Ho, MBBS (S’pore), MRCS (Edin), MMed (Gen Surg), Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore. E-mail: lilming2000@gmail.com.

© 2014 by Lippincott Williams & Wilkins