Use of dorsalis pedis artery flap in coverage of distal lower leg defects
DOI:
https://doi.org/10.18203/2320-6012.ijrms20232169Keywords:
Dorsalis pedis artery flap, Lower limb reconstruction, Diabetic foot, Pedicled flap, Local flaps, Lower limb defectAbstract
Soft tissue defect in the distal one third of leg have always posed a challenge for reconstructive surgeons. Such wounds are difficult to manage due the tenuous blood supply, limited subcutaneous cover over the tendons and bones. The aim of our study is to investigate the outcome of Dorsalis pedis artery flap for the coverage of such defects. In the present study, we share our clinical experience with the use of dorsalis pedis artery flap for the coverage of defect in the distal one third leg. This is a series of 4 cases where dorsalis pedis artery flap was used to cover lower one third defect. One case had focal squamous cell carcinoma due to long standing post burns contracture in distal one third of leg anteriorly. Other 3 cases had chronic non healing ulcer in the malleolar region. Patient outcome was assessed according to patients’ age distribution, duration of surgery, hospital stay, and post-operative complications. All 4 patients had excellent outcome with no major donor site complications, infection, and graft loss. Donor site was closed with split thickness skin graft. One patient developed a minor raw area over the dorsum of foot which healed secondarily. Although a potential risk in applying this flap is insufficient venous drainage, no problems with blood inflow or outflow were encountered in the present case series. The flaps survived, and the patient had good postoperative outcome. Hence dorsalis pedis flap can be used for the coverage of the distal foot as a good option.
References
Barclay TL, Cardos E, Sharpe DT. Cross leg facsiocutaneus fl aps. Plast Reconstr Surg. 1983;72:843-7.
May JW Jr, Gallico GG 3rd, Lukash FN. Microvascular transfer of free tissue for closure of bone wounds of the distal lower extremity. N Engl J Med. 1982;306:253-7.
Tolhurst DE, Haeseker B, Zeeman RJ. The development of the fasciocutaneous flap and its clinical applications. Plast Reconstr Surg. 1983;71:597-606.
Akhtar S, Hameed A. Versatility of the suralfasciocutaneous fl ap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg. 2006;59:839-45.
Mathes S, Nahai F. Clinical application of muscles and musculocutaneus fl aps. St. Louis: Mosby. 1982.
Rainer C, Schwabegger AH, Bauer T, Ninković M, Klestil T, Harpf C et al. Free fl ap reconstruction of the foot. Ann Plast Surg. 1999;42:595-607.
Langstein HN, Chang DW, Miller MJ, Evans GR, Reece GP, Kroll SS et al. Limb salvage for soft-tissue malignancies of the foot: An evaluation of free-tissue transfer. Plast Reconstr Surg. 2002;109:152-9.
vanLanduyt K, Hamdi M, Blondeel P, Monstrey S. The compound thoracodorsal perforator fl ap in the treatment of combined soft-tissue defects of sole and dorsum of the foot. Br J Plast Surg. 2005;58:371-8.
McCraw JB, Furlow LT Jr. The dorsalispedis arterialized flap. Plast Reconstr Surg. 1975;55:177-85.
Caffe HH, Hoeffl in SM. The extended dorsalispedis flap. Plast Reconstr Surg. 1979;64:807-10
Yaremchuk MJ, Brumback RJ, Manson PN. Acute and definitive management of traumatic osteocutaneous defects of the lower extremity. Plast Reconstr Surg. 1987;80:1-14.
Tropet Y, Garbuio P, Obert L. Emergency management of type IIIB open tibial fractures. Br J Plast Surg. 1999;52:462-70.
Nuzumlali E, Gurbuz C, Kantarci U. Moving car-tire injuries of the foot: reconstruction with microvascular free flaps. J Reconstr Microsurg. 1996;12:297-302.
Chiang YC, Jeng SF, Yeh MC. Free tissue transfer for leg reconstruction in children. Br J Plast Surg. 1997;50:335-42.
Lai CS, Lin SD, Yang CC. Adipofascial turn-over flap for reconstruction of the dorsum of the foot. Br J Plast Surg. 1991;44:170-4.
Ismail TI. The dorsalis pedis myofascial flap. Plast Reconstr Surg. 1990;86:573-6.
Morrison WA, Shen TY. Anterior tibial artery flap: anatomy and case report. Br J Plast Surg. 1987;40:230-5.
Hong G, Steffens K, Wang FB. Reconstruction of the lower leg and foot with the reverse pedicled posterior tibial fasciocutaneous flap. Br J Plast Surg. 1989;42:512.
Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg: anatomical basis and clinical applications. Plast Reconstr Surg. 2005;115:793-801.
Lin SD, Lai CS, Tsai CC. Clinical application of the distally based medial adipofascial flap for soft tissue defects on the lower half of the leg. J Trauma. 1995;38:623-9.
Yoshimura M, Imura S, Shimamura K. Peroneal flap for reconstruction in the extremity: preliminary report. Plast Reconstr Surg. 1984;74:402-9.
Attinger CE, DucicI, Cooper P. The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients. Plast Reconstr Surg. 2002;110:1047-54
Arnold PG, Yugueros P, Hanssen AD. Muscle flaps in osteomyelitis of the lower extremity: a 20-year account. Plast Reconstr Surg. 1999;104:107-10.
Russo A, Delia G, Casoli V. Dorsalis Pedis Adipofascial Perforator flap for great toe reconstruction: anatomical study and clinical applications. J Plast Reconstr Aesthet Surg. 2014;67:550-4.
El-Khatib HA. Adipofascial turn-over flap based on perforators of the dorsalis pedis for resurfacing forefoot defects: an anatomic and clinical approach. Plast Reconstr Surg. 1998;102:393-7.