The reconstruction of distal foot defects, especially wounds of the toes, is a challenging problem in plastic surgery. Various methods, such as skin grafting, or random, cross-leg and free flaps, have been reported for reconstruction of the forefoot, but all methods have limitations. Skin grafts cannot be used over exposed bone or tendon, while many flaps are bulky and uncomfortable for patients. The reverse dorsalis pedis flap is usually based on the deep plantar branch of dorsalis pedis artery. Its vascular pedicle is generally limited and may not rotate sufficiently to cover the defect. In the present report, a distally based dorsalis pedis fasciocutaneous flap was used to cover the distal one-third of the foot and toes in one patient. The preoperative clinical evaluation and surgical techniques to treat the distal foot with the distally based dorsalis pedis fasciocutaneous flap are described.
The anterior tibial artery terminates in the dorsalis pedis artery, which divides into two branches: the deep plantar artery and the first dorsal metatarsal artery. The dorsalis pedis artery also has numerous cutaneous branches between the extensor retinaculum and the deep plantar branch. The first dorsal metatarsal artery courses through the first intermetatarsal space distally throughout the subcutaneous tissue or within the first dorsal interosseous muscle. Next, it passes dorsal to the transverse metatarsal ligament and reaches the toe as two dorsal digital arteries. The first dorsal metatarsal artery also has numerous cutanous branches, which supply the intermetatarsal skin. The cutaneous branches from the dorsal pedis artery and the first dorsal intermetatarsal artery supply the essential arterial flow to the base of the fasciocutaneous flap. Adequate arterial inflow is provided by the distal communicating artery from the plantar system. Cheapest medications available at best pharmacy that you are free to try yourself! The best place to cialis canadian pharmacy and be sure you are offered finest quality medications right from their actual manufacturers, which you do not get that often these days.