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Anatomic basis and clinical application of the distally based medialis pedis flaps

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Abstract

Background

Soft-tissue defects of the forefoot are difficult to cover adequately, particularly, although multiple options for reconstruction are available. This study especially focused on the vascularization of the medial side of the foot and the determination of the contribution of the nutrient vessels to medialis pedis flap viability.

Methods

Thirty cadavers were available for this anatomical study. Microdissection was conducted under a microscope, and details of the course and distribution and the communication of the first plantar metatarsal artery with the fascial vascular network of the medial side of the foot were recorded. Clinically, six cases of soft-tissue defects at the forefoot region were reconstructed with distally based medialis pedis flap.

Results

The perforator of the first plantar metatarsal artery pierces in the superficial fascia of the medial aspect of the foot 2.2 ± 0.7 cm proximal to the first metatarsophalangeal joint, vascularize the skin of the medial plantar region. The anatomical study showed that the vasculature pattern could roughly be classified into two types. In terms of clinical application, all flaps completely survived, and one patient had partial loss of skin graft.

Conclusion

The perforators of the medialis pedis flap are presented constant. The forefoot region can be repaired by the distally based medialis pedis flap on the perforator of the medial plantar artery of the hallux or the first plantar metatarsal artery perforator with medial plantar vein, medial plantar cutaneous nerve and nutrient vessels.

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Acknowledgments

This project was supported by Nanjing military region major projects of the innovation of medical science and technology (ZX30). This project was supported by Hunan Provincial Science Foundation grant (13JJ5012).

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    Authors and Affiliations

    1. Department of Head and Neck Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China

      Dajiang Song

    2. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China

      Dajiang Song

    3. Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China

      Dajiang Song & Chunlin Hou

    4. Department of Hand and Foot Surgery, Yiwu Central Hospital, Zhejiang, China

      Xiaodong Yang

    5. Department of Comparative Medicine, General Hospital of People’s Liberation Army Nanjing District, Fujian Medical University, Fuzhou, 350108, China

      Zedong Wu, Lei Li, Tianquan Wang & Heping Zheng

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    1. Dajiang Song
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    Correspondence to Heping Zheng or Chunlin Hou.

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    The authors have no financial interests to declare in relation to the content of this article.

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    D. Song and X. Yang contributed equally to this work.

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    Song, D., Yang, X., Wu, Z. et al. Anatomic basis and clinical application of the distally based medialis pedis flaps. Surg Radiol Anat 38, 213–221 (2016). https://doi.org/10.1007/s00276-015-1532-6

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    • DOI: https://doi.org/10.1007/s00276-015-1532-6

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