Vasculature at the medial aspect of the foot and clinical application of flaps based on it for forefoot reconstruction.

Abstract

Detailed knowledge of the vasculature of the medial aspect of the foot has rarely been reported, but it is of tremendous importance for harvesting the flap in this area to cover defects of the foot and hand. Repair of soft-tissue defects at the dorsal forefoot remains a challenge in reconstructive surgery. The authors describe the use of the distally based saphenous neurovenofasciocutaneous flap at the medial aspect of the foot to cover this region. This study was divided into two parts: an anatomical study and clinical application. In the anatomical study, 35 cadaveric feet were injected with red gelatin, five others were made as corrosive vascular casts, and then the main vessels distributed at the medial aspect of the foot were observed. Clinically, six cases of soft-tissue defects at the dorsal forefoot were reconstructed with distally based saphenous neurovenofasciocutaneous flaps. The anatomical study showed that (1) the vasculature pattern could roughly be classified into three types and (2) there were constant anastomoses between the above-mentioned arteries around the midpoint of the first metatarsal bone. In terms of clinical application, all flaps completely survived, and one patient had partial loss of skin graft. The blood supply to the medial aspect of the foot has multiple origins, on the basis of which of several flaps can be harvested, either a pedicled or free. Of particular clinical significance is the distally based saphenous neurovenofasciocutaneous flap, which is thin, is in the immediate vicinity of the forefoot, and has a reliable retrograde blood supply. This flap should be considered as a preferential way to reconstruct soft-tissue defects of the dorsal forefoot.