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Table of Contents
LETTER TO THE EDITOR
Year : 2022  |  Volume : 30  |  Issue : 4  |  Page : 131-132

The first dorsal metatarsal artery adipofascial perforator flap: A useful salvage method for dorsal defects of distal foot


Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey

Date of Submission17-May-2022
Date of Acceptance08-Jul-2022
Date of Web Publication09-Sep-2022

Correspondence Address:
Dr. Oguz Eker
Selçuk University, Ardiçli, Akademi, Celal Bayar Cd. No: 313, 42250 Selçuklu, Konya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_33_22

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How to cite this article:
Eker O, Dogramaci A, Sutcu M, Tosun Z. The first dorsal metatarsal artery adipofascial perforator flap: A useful salvage method for dorsal defects of distal foot. Turk J Plast Surg 2022;30:131-2

How to cite this URL:
Eker O, Dogramaci A, Sutcu M, Tosun Z. The first dorsal metatarsal artery adipofascial perforator flap: A useful salvage method for dorsal defects of distal foot. Turk J Plast Surg [serial online] 2022 [cited 2022 Sep 29];30:131-2. Available from: http://www.turkjplastsurg.org/text.asp?2022/30/4/131/355811




  Introduction Top


The foot is a multijointed mechanical structure that is critical to the biomechanical function of the lower extremity. The reconstruction of dorsal defects of the distal foot and the great toe can be problematic surgically due to poor vascularity, limited skin laxity, and mobility. In this study, we present a useful salvage method with the first dorsal metatarsal artery adipofascial perforator flap for traumatic injuries of dorsal defects of the distal foot.


  Case History and Surgical Technique Top


A 58-year-old male patient was admitted with a crush injury around the first dorsal metatarsal joint. Skin and soft-tissue defects were formed around the first metatarsophalangeal joint, extending to the dorsal of the first finger. The extensor hallucis longus tendon and metatarsophalangeal joint were exposed.

The proximal border of the defect and the distal border of the extensor retinaculum were marked. A Doppler was used to locate the distal perforator of the first dorsal metatarsal artery. A skin incision was made between the two landmarks. The adipofascial flap was elevated from proximal to distal. The proximal perforator branches were ligated. The flap was elevated to the Doppler-determined location and the distal perforator was skeletonized. We kept above the paratenon plane to preserve tendon vascularization. The superficial peroneal nerve was preserved. The flap was turned over into a defect. The venous drainage was maintained by the superficial dorsal venous network and the dorsal metatarsal veins. A split-thickness skin graft was adapted over the flap. The donor area was primarily sutured [Figure 1] and [Figure 2].
Figure 1: (a) Preoperative image and (b) postoperative 1-month image

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Figure 2: Schematic illustration of the flap

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  Discussion Top


The reconstruction of dorsal defects in the distal foot might be problematic. Many reconstruction options were described, and they have specific disadvantages.[1]

Long-term durability is a common issue with grafts, and the defects in this area are frequently complicated by exposed tendons or bones, making skin grafts unfeasible.[1] Usage of the local muscle flaps or free flaps may provide good coverage, but mostly they are too bulky. This causes functional problems with shoe wear. Free flaps are associated with technical difficulties and less than optimum cosmetic and functional outcomes.[1]

Although dorsal pedal flaps might be used on a distal basis, there is a substantial risk of donor site sequela.[2],[3] Instead, the first dorsal metatarsal artery perforator flap (FDMtAP) is a preferable choice, especially to reduce donor site healing difficulties.[4] FDMtAP flap restores soft tissue without dissecting the pedicle. This minimizes donor site morbidity and surgery time by avoiding intramuscular dissection. An adipofascial version of FDMtAP, rather than the fasciocutaneous form, may also produce a larger-sized flap, a larger rotation arc, and largely avoid donor site morbidity, but needs skin graft at the recipient site.[5] Raising this adipofascial flap based on the perforator may allow the flap to be used to cover more distal defects and to gain a more stable blood supply.

The first dorsal metatarsal artery adipofascial perforator flap appears to be a safe, rapid, and simple procedure for reconstructing the dorsum of the distal foot and great toe defects, as it provides optimal functional and esthetic outcomes with minimal donor site morbidity.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Serletti JM, Moran SL. Soft tissue coverage options for dorsal foot wounds. Foot Ankle Clin 2001;6:839-51.  Back to cited text no. 1
    
2.
Cheng MH, Ulusal BG, Wei FC. Reverse first dorsal metatarsal artery flap for reconstruction of traumatic defects of dorsal great toe. J Trauma 2006;60:1138-41.  Back to cited text no. 2
    
3.
Hallock GG. Distally based flaps for skin coverage of the foot and ankle. Foot Ankle Int 1996;17:343-8.  Back to cited text no. 3
    
4.
Yeo CJ, Sebastin SJ, Ho SY, Tay SC, Puhaindran ME, Lim AY. The dorsal metatarsal artery perforator flap. Ann Plast Surg 2014;73:441-4.  Back to cited text no. 4
    
5.
Suliman MT. Distally based adipofascial flaps for dorsal foot and ankle soft tissue defects. J Foot Ankle Surg 2007;46:464-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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Discussion
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