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The First Dorsal Metatarsal Artery Perforator Propeller Flap

Hallock, Geoffrey G. MD

doi: 10.1097/SAP.0000000000000264
Reconstructive Surgery

Background Distal foot and toe defects requiring a vascularized flap for coverage have very limited options, oftentimes justifying even a free flap. Perforator flaps in general and propeller flaps in particular have opened up an entirely new subset of local tissue transfer alternatives that can potentially avoid the difficulties that accompany microvascular tissue transfers. The first dorsal metatarsal artery (FDMA) perforator propeller flap represents another variation of this theme.

Methods A standard FDMA flap from the dorsum of the foot was raised in reversed fashion based on the distal communicating branch or “perforator” from the plantar foot circulation in 2 patients with great toe defects. All distal skin tissue between this perforator and the defect was kept with the FDMA flap as an attached minor blade, to thereby create an FDMA propeller flap.

Results Salvage of the great toe in both patients was achieved. The benefit of the minor blade of the propeller was to fill a portion of the donor site defect of the traditional FDMA major blade, to permit tension-free donor site closure of the dorsal foot without sequela.

Conclusions The distal-based FDMA flap can be useful as a local flap for coverage of distal foot and toe wounds, but direct donor site closure can be problematic as mirrored by its relative the dorsalis pedis flap. The FDMA perforator propeller flap variation can achieve the same reconstructive goals while simultaneously transferring vascularized tissue into the dorsal foot donor site to thereby minimize the tension if direct closure is possible or minimize the need for a skin graft in this notoriously difficult region.

From the Division of Plastic Surgery, Sacred Heart and The Lehigh Valley Hospitals, Allentown, and St. Luke’s Hospital, Bethlehem, PA.

Received January 5, 2014, and accepted for publication, after revision, April 10, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Geoffrey G. Hallock, MD, Division of Plastic Surgery, Sacred Heart and The Lehigh Valley Hospitals, Allentown, and St. Luke’s Hospital, Bethlehem, Pennsylvania, 1230 S. Cedar Crest Blvd., Suite 306, Allentown, Pennsylvania, 18103. E-mail:

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