Background
Dorsal metatarsal vascular system can be used to create axial type local flaps as same as the dorsal hand DMCA flaps in foot reconstructive surgery. This short case series describes it’s uses in clinical practice.
Methodology
This is a prospective and descriptive case series where 3 patients were included. Two patients (29F & 35F) had scar contractures over the distal dorsal foot and toes with fictional compromise and causing difficulty in wearing footwear and mobilization. Third patient is a 59 year old patient with an ulcer over the EHL exposing the tendon and he had microvascular complications of DM.
Dorsal metatarsal artery(DMTA) perforator was Doppler marked preoperatively. After the scar contracture releasing surgery or after the debridement of the wound an axial flap was designed based on the perforator and its axial vessels. Exploratory incision is first made lateral to the perforator and its anatomy is observed. DMTA perforator based flap is elevated including its longitudinal subcutaneous branches and plexuses. Flap inserted to cover the dorsal foot defect without any undue tension. Secondary defects were closed primarily or skin grafted.
Results
All flaps showed good perfusion in early post operative period. Young patients with scar releases recovered uneventfully with good flap and graft recovery. With subsequent scar management they achieved normal toe alignment and function.
Expectedly the diabetic patient developed late epidermal necrosis with mild congestion of the flap. It was managed conservatively and recovered well. There were no infections and wound dehiscence although it took about 4 weeks for it to completely recover.
Discussion/Conclusion
DMTA perforator flap is an axial flap with reverse flow perfusion. With an exploratory incision perforator and vascular anatomy can be assessed before the flap elevation so we can harvest a longer, more reliable and robust flap compared to an otherwise random flap design.