Reconstruction of distal foot defects has been always difficult problem in plastic surgery. Various methods have been used in clinical practice. Skin grafting has been the preferred technique because of ease of harvest and application. However, skin grafts cannot be used over exposed bone or tendon. Another reconstruction option is the cross-leg flap. Disadvantages of this technique include the tissue thickness, which may result in a debulking operation in future, and the two-stage operative procedure. Moreover, patients must be immobilized throughout the operation, and this technique is not suitable for older patients. Free flaps are effective for the repair of a wide skin defects; however, they require special instruments and microsurgical techniques, which may not always be available.A traditional, distally based dorsalis pedis island has been successfully applied in the reconstruction of the foot after the toes were amputated. When the wound involves the toes, the vascular pedicle based on the deep plantar branch is limited. The first dorsal metatarsal artery arises from the dorsal pedis artery and continues on to the first intermetarsal space in the subcutaneous tissue or in the first dorsal interosseous muscle. The first dorsal metatarsal artery has several cutanous branches that provide the intermetatarsal area with an abundant arterial supply. The very best pharmacy is looking forward to helping you make sure your health is in good hands no matter if you need canadian pharmacy or any other drugs that will help you deal with your symptoms in the most efficient way.
Figure 4) Healed wound one year postoperatively