Reconstruction of great toe skin defect with retrograde-flow medial pedis island flap used transverse artery of great toe / 中华显微外科杂志

ABSTRACT

Objective To explore the methods of repairing great toe soft tissue defect with the reverse medial pedis island flap with transverse artery of great toe.Methods This study was made up of two partsan anatomical study and clinical application.In the anatomical study,49 cadaveric feet were injected with red latex and then anostomosis,distribution and external diameters of transverse artery of great toe,the deep branches of the first plantar metatarsal arteries and the deep branches of medial plantar artery were observed.From September 2006 to December 2012,8 cases of soft-tissue defects with the retrograde-flow medial pedis island flaps were harvested to cover the soft tissue defects of great toe.Soft tissue defect was form 2.5 cm × 3.5 cm-3.5 × 4.5 cm.Results There was an arterial circle under the first metatarsophalangeal joint which consisted of transverse artery of great toe,tibial proper plantar digital artery of great toe,fibular proper plantar digital artery of great toe and the distal part of first plantar metatarsal artery.This arterial circle under the first metatarsophalangeal joint and arterial network on the surface of abductor hallucis was responsible for the blood supply of the flap of medial pedis.The diameter of the pedicle was great,and the length of the pedicle was longer than in previous reported.In terms of clinical application,all patients were followed up with the mean of 10 months (range fromn 6-24 months).All flaps survived totally without diabrosis and swelling.The walking and weight-bearing were normal and the blood supply of foot was good.Conclusion Using of arterial circle under the first metatarsophalangeal joint,the medial pedis island flap has a reliable retrograde blood supply.The reverse point of the reverse medial pedis flap moved forward to th interphalangeal joint.This flap should be considered as a preferential way to reconstruct soft-tissue defects of the great toe.