Anatomical review of dorsalis pedis artery flap for the oral cavity reconstruction

The dorsalis pedis artery (DPA) was renamed from the anterior tibialis artery after it passed under the extensor retinaculum, and DPA travels between the extensor hallucis longus and extensor digitorum longus muscle along the dorsum of the foot. After giving off the proximal and distal tarsal, arcuate and medial tarsal branches, DPA enters the proximal first intermetatarsal space via the first dorsal metatarsal artery (FDMA), which courses over the first dorsal interosseous muscle (FDIM). For detailed knowledge of the neurovascular anatomy of a dorsalis pedis artery flap (DPAF) as a routine reconstructive procedure after the resection of oral malignant tumors, the precise neurovascular anatomy of DPAF must be studied along the DPA courses as above. In this first review article in the Korean language, the anatomical basis of DPAF is summarized and discussed after a delicate investigation of more than 35 recent articles and atlas textbooks. Many advantages of DPAF, such as a consistent flap vascular anatomy, acceptable donor site morbidity, and the ability to perform simultaneous flap harvest using oral cancer ablation procedures, and additional important risks with the pitfalls of DPAF were emphasized. This article will be helpful, particularly for young doctors during the special curriculum periods for the Korean National Board of Specialists in the field of oral and maxillofacial surgery, plastic surgery, otolaryngology, orthopedic surgery, etc.

Morphological Study on the Dorsalis Pedis and First Dorsal Metatarsal Arteries in Koreans / 대한해부학회지

Morphological variation of the dorsalis pedis and the first dorsal metatarsal arteries are important because these arteries are used as flap pedicles during surgery of hands and feet with tissue defects. The purpose of this study was to investigate variations in the running pattern of the dorsalis pedis and first dorsal metatarsal arteries. We investigated the dorsalis pedis artery in 92 adult cadaver feet and 50 first dorsal metatarsal arteries that arose from these dorsalis pedis arteries were studied. The dorsalis pedis artery was classified into six types according to its running direction. The dorsalis pedis artery running in the direction of the first intermetatarsal space and branching into the first dorsal metatarsal artery was observed in 79.3%. The dorsalis pedis artery coursing laterally and becoming the first dorsal metatarsal artery after changing its direction medially was seen in 5.4%. The dorsalis pedis artery was thin and did not connect to the first dorsal metataral artery, split in the region of ankle and came to an end, and ran laterally and did not connect to the first dorsal metatarsal artery in 8.7%, 2.2%, and 3.7%, respectively. The dorsalis pedis artery ran superficial to the deep fascia in 1 of the 92 specimens (1.1%). The first dorsal metatarsal artery was classified into three types according to the positional relationship between the first dorsal metatarsal artery and the first dorsal interosseous muscle. The first dorsal metatarsal artery ran above or into the first dorsal interosseous muscle in 72% and ran below the first dorsal interosseous muscle in 22%. The first dorsal metatarsal artery that was either above or inside the first dorsal interosseous muscle but could not used as a flap pedicle because it was too small was seen in 6%.