J Korean Assoc Oral Maxillofac Surg.  2011 Jun;37(3):184-194. 10.5125/jkaoms.2011.37.3.184.

Anatomical review of dorsalis pedis artery flap for the oral cavity reconstruction

• Kim SM
• Kang JY
• Eo MY
• Myoung H
• Lee SK
• Lee JH

• KMID: 2189771
• DOI: http://doi.org/10.5125/jkaoms.2011.37.3.184

Abstract

The dorsalis pedis artery (DPA) was renamed from the anterior tibialis artery after it passed under the extensor retinaculum, and DPA travels between the extensor hallucis longus and extensor digitorum longus muscle along the dorsum of the foot. After giving off the proximal and distal tarsal, arcuate and medial tarsal branches, DPA enters the proximal first intermetatarsal space via the first dorsal metatarsal artery (FDMA), which courses over the first dorsal interosseous muscle (FDIM). For detailed knowledge of the neurovascular anatomy of a dorsalis pedis artery flap (DPAF) as a routine reconstructive procedure after the resection of oral malignant tumors, the precise neurovascular anatomy of DPAF must be studied along the DPA courses as above. In this first review article in the Korean language, the anatomical basis of DPAF is summarized and discussed after a delicate investigation of more than 35 recent articles and atlas textbooks. Many advantages of DPAF, such as a consistent flap vascular anatomy, acceptable donor site morbidity, and the ability to perform simultaneous flap harvest using oral cancer ablation procedures, and additional important risks with the pitfalls of DPAF were emphasized. This article will be helpful, particularly for young doctors during the special curriculum periods for the Korean National Board of Specialists in the field of oral and maxillofacial surgery, plastic surgery, otolaryngology, orthopedic surgery, etc.

Keyword

Anterior tibial artery; Dorsalis pedis artery flap (DPAF); First dorsal interosseous muscle (FDIM); First dorsal metatarsal artery (FDMA); Oral cancer

MeSH Terms

Arteries
Curriculum
Foot
Humans
Metatarsal Bones
Mouth
Mouth Neoplasms
Muscles
Orthopedics
Otolaryngology
Specialization
Surgery, Oral
Surgery, Plastic
Tibial Arteries
Tissue Donors

Figure

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  Fig. 1. Basic anatomy of the arteries and muscles of the dorsalis pedis artery flap.

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  Fig. 2. Arterial systems of the dorsum of left foot.

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  Fig. 3. Schematic drawing of arterial communications between DPA with FDMA and proximal communicating artery with FPMA.(DPA: deep plantar artery, FDMA: first dorsal metatarsal artery, FPMA: first plantar metatarsal artery)

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  Fig. 4. Schematic drawings of various patterns of the FDMA according to the positional relationship between the FDMA and the FDIM. Type I-A; the FDMA is superficial to the FDIM, Type I-B; the FDMA begins at the bottom of the FDIM and penetrates muscle with ascending up the FDIM, and then running on the surface, Type I-C; the FDMA penetrates the FDIM, and then runs into the muscle, Type II-A; large FDMA runs under the FDIM, and small FDMA runs on the FDIM; Type II-B; there is the same disposition of the artery as type II-A, but there is no superficial branch, Type III; there is the FDMA on or inside of the FDIM, but the artery is not so large as to use as a free flap pedicle.(FDMA: first dorsal metatarsal artery, FDIM: first dorsal interosseous muscle)

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  Fig. 5. Schematic drawings of variation patterns of the DPA. A; about 3% cases of DPA begins as a continuation of the perforating peroneal artery, B; the lower end of the anterior tibial artery is in the position of the perforating peroneal artery in about 1.5% of cases of DPA, C; about 0.5 % cases of DPA can arise equally from the anterior tibial and perforating peroneal arteries, D; about 12% cases of DPA are almost absent or reduced in size.(DPA: deep plantar artery)

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  Fig. 6. Cross sectional view through the left metatarsus.

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  Fig. 7. Muscles and tendons of the dorsum of foot.

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  Fig. 8. Muscle and tendon marking with different suture materials.

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  Fig. 9. Cutaneous nerves and veins of the dorsum of left foot.

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