Microvascular Free Transfer of A Compound Dorsalis Pedis Skin Flap With Second Metatarsal Bone
Using the long leash of the dorsalis pedis anterior tibial arterial system, a more assured blood supply can be found. The vessels can then be brought down to the neck to the external carotid and jugular systems. Use of the temporal artery is not as secure as use of the larger arterial vessel.
Total nasal reconstruction can be achieved by including the second metatarsal bone with a free dorsalis pedis skin flap (1).
There are not many indications for use of this procedure, especially when the patient has normal forehead and cheek skin.
Based on my clinical experience, it is unnecessary to keep all the small branches of the dorsalis pedis or the first dorsal metatarsal arteries intact. For example, I routinely pull out the extensor brevis muscle after severing its tendon.
Either the cutaneous vein (which is directly connected to the greater and lesser saphenous veins) or the venae comitantes of the anterior tibial, dorsalis pedis, and first dorsal metatarsal arteries can be selected. However, to obtain the long vascular pedicle needed for this flap, it is easier to use the venae comitantes.
FLAP DESIGN AND DIMENSIONS
The entire dorsal aspect of the foot can be used. If necessary, the flap can be extended to include the skin overlying the second toe. Both the second metatarsus and the toe itself can be included.
The axis of the flap should lie over the course of the dorsalis pedis or first dorsal metatarsal artery. The flap should be centralized over the base of the second metatarsal bone (Figs. 67.1 and 67.2).