OBJECTIVETo investigate the vascular supply of intrinsic muscles of foot and anatomic basis for muscular flap design.

METHODSA radiopaque injectate (lead oxide-gelatin mixtures, 26 ml/kg) was injected into 10 fresh cadavers. The dissected regions were photographed and each intrinsic muscles on the foot was removed and radiographed. The number, type, diameter of vascular branches of muscles and their distributions were observed. The area of the vascular territory supplied by each source vessel was calculated using Scion Image for Windows software.

RESULTSThere were significant architectural differences among the intrinsic muscles. The muscles length varied from 22.5mm to 116.2mm [average, (66.1 +/- 23.2)mm]. The measured fiber length were relatively consistent, ranging from 14.2 mm to 27.5 mm [average, (20.2 +/- 4.5)mm]. There are 63 vascular branches into the 23 foot muscles, each muscle having average branches of 3.2 +/- 0.8. The average diameter of branches, the length and width of each vascular territorial area is (0.8 +/- 0.3) mm, (2.2 +/- 0.8) cm, and (0.9 +/- 0.4) cm, respectively. Other findings included that some muscles were not present in some cadavers.

CONCLUSIONSThe blood supply of intrinsic muscles of foot is abundant with different diameter and distributions of branches. There is an anatomic basis for muscular or musculoosseous flap design. There are 7 intrinsic muscles with large and reliable vascular supply which can be chosen as muscular flaps.

Adult ; Foot ; blood supply ; Humans ; Muscle, Skeletal ; blood supply ; Surgical Flaps

Adult ; Aged ; Ankle ; blood supply ; Arteries ; Diabetic Foot ; diagnosis ; physiopathology ; Elbow ; blood supply ; Female ; Foot ; blood supply ; Humans ; Laser-Doppler Flowmetry ; Male ; Middle Aged

OBJECTIVETo explore the blood supply of the reverse arterial arch at the superior border of the hallucal abductor island flap and provide an anatomical basis for repairing fore foot skin defect using this flap.

METHODSThe constitution, course, distribution, and external diameter of the arterial arch at the superior border of the hallucal abductor, and the concomitant veins and nerves were observed on 12 sides of formaldehyde-fixed and 12 fresh adult foot specimens perfused with red latex. The surgical approach using the arterial arch at the superior border of the hallucal abductor for repairing fore foot skin defect were designed.

RESULTSThe arterial arch at the superior border of the hallucal abductor, constituted by the branch of the medial tarsal artery or the branch of the anterior medial malleolus artery anastomosed with the superficial branch of the medial basal hallucal artery or the branch of the superficial branch of the medial plantar artery or the all the four branches, functioned as the axis of the medial tarsal, the medialis pedis and the medial plantar. The external diameters of the anterior medial malleolus artery, the medial tarsal artery, the branch of the superficial branch of the medial plantar artery, and the distal arterial arch at the superior border of the hallucal abductor were 1.02∓0.03 mm, 0.73∓0.04 mm, 0.56∓0.02 mm, and 0.53∓0.14 mm, respectively. Most of the arteries (91.67%) had one concomitant vein with the external diameters of 1.01∓0.03 mm, 0.81∓0.04 mm, 0.57∓0.01 mm, and 0.61∓0.02, respectively, and only a small fraction of them (8.33%) had two concomitant veins.

CONCLUSIONSThe fore foot skin defect can be repaired using this flap supplied by the branch of the anterior medial malleolus artery and the medial tarsal artery, the superficial branch of the medial plantar artery, or all the three. The pivot point formed by the neck of the first metatarsal or metatarsophalangeal joint allows for long vessel pedicles and larger flap areas to increase the flexibility of surgery.

Foot Injuries ; surgery ; Humans ; Muscle, Skeletal ; anatomy & histology ; blood supply ; Skin ; injuries ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply

OBJECTIVETo investigate the clinical effect of reversed plantar metatarsal artery island flap in repairing the plantar soft tissue defects at the first and second toes.

METHODS12 cases with plantar soft tissue defects at the first and second toes were repaired by reversed plantar metatarsal artery island flap which size ranged from 2 cm x 3 cm to 4 cm x 6 cm, including 5 cases at emergency, 5 cases with the donor site defects at great toes after free lateral pulp flap transfer, and 2 cases with the donor site defects at second toes after free medial pulp flap transfer.

RESULTSAll the reversed plantar metatarsal artery island flaps at the first and second toes survived uneventfully with desirable appearance and sensation over a 3-35 month follow-up. No complication happened at the donor sites.

CONCLUSIONSIt is an reliable method to adopt the reversed plantar metatarsal artery island flap for the plantar soft tissue defects at the first and second toes, with the advantages of stable blood vessels, high survival rate, good skin texture and few complications.

Arteries ; Foot ; Humans ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; transplantation ; Toes ; Transplant Donor Site ; blood supply

A 68-year-old female patient was treated for unhealed ulcer in the fourth toe of the left foot. Clinical examinations identified severe stenosis of the proximal segment and occlusion of the distal segment of the left anterior tibial artery, and occlusion of the left posterior tibial artery and the peroneal artery. The proximal stenotic segment of the left anterior tibial artery was dilated, but the distal occlusive part failed to be re-canalized. Left anterior tibial artery to dorsal pedal artery bypass was performed on the patient with an epoxide-crosslinked, special radicals antigen-sealed, porcine-derived biological graft; debridement of the left 4th digiti pedis was also performed. Postoperation course was uneventful. The pulse of the left dorsal pedal artery was strong. The ankle brachial index (ABI) increased from 0.60 to 1.09. Warfarin and two antiplatelet drugs were given after the operation. Six months after operation, computed tomographic angiogram (CTA) identified the patent graft.
Aged ; Blood Vessel Prosthesis ; Diabetic Foot ; surgery ; Female ; Humans ; Ischemia ; surgery ; Leg ; blood supply

OBJECTIVETo evaluate the effect of lateral supramalleolar artery descending branch antidromic flap for the repair of soft tissue defects in the foot and ankle.

METHODSFrom May 2009 to October 2013,12 patients with soft tissue defects combined with tendon and bone exposure in the foot and ankle were treated by lateral supramalleolar artery descending branch antidromic flap for the repair of soft tissue defects in the foot and ankle, including 9 males and 3 females with an average age of 37.5 years old ranging from 19 to 58 years. Ten cases had the soft tissue defects in the dorsum of foot and 2 in the ankle. The defect area of soft tissue was from 11 cm x 9 cm to 8 cm x 5 cm.

RESULTSTwelve patients were follow-up for 3 to 12 months (averaged 7.3 months). The flaps of 9 cases were survived,the flaps edges of the other 3 cases were necrosis,and healed after dressing change. The flaps were slightly swelling without ulcer occurrence.

CONCLUSIONLateral supramalleolar artery descending branch antidromic flap can repairing the damage by one-stage operation with advantage of dissection easy,rich blood supply without sacrifice of major artery.

Adult ; Ankle ; blood supply ; surgery ; Arteries ; surgery ; Female ; Foot ; blood supply ; surgery ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Young Adult

No abstract available.
Endovascular Procedures/*methods ; Female ; Foot/*blood supply ; Humans ; Ischemia/*surgery ; Male ; Wound Healing/*physiology

OBJECTIVETo investigate the therapeutic effect of island flap pedicled with lateral tarsal artery for forefoot skin defect.

METHODSFrom March 2007 to January 2009, 12 cases with forefoot skin defects were treated by reversed island flap pedicled with lateral tarsal artery.

RESULTSAll the flaps survived completely with a followed-up period of 8-22 months, 13 months in average. The flaps and skin grafts had soft texture and a similar color as the surrounding skin. The flaps had a suitable thickness with deep pain sensation. Shallow touch and pain sensation recovered in the skin graft and within 1-2 cm of the flap edge, which was graded as S1-S2. There was no problem in shoes-wearing and walking. No flap ulcer happened.

CONCLUSIONIsland flap pedicled with lateral tarsal artery is suitable for forefoot skin defect, leaving less morbidity to donor site.

Adult ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply

OBJECTIVETo investigate the anatomy of the medial pedis composite flaps with saphenous nerve and tendon and its application in the repair of tendo calcaneus and adjacent defects.

METHODS10 cadavers (20 sides) were observed. The origin, course, size and the distribution of the medial plantar artery were studied. 12 cases with tendo calcaneus and adjacent defects were reconstructed with the medial pedis composite flaps with saphenous nerve. Donor site defects were covered with free skin graft.

RESULTSThe medial plantar artery gives off deep branch [diameter (1.5 +/- 0.3) mm] and superficial branch [diameter (1.0 +/- 0.2) mm]. In 18 sides, the deep branches give off the medial branches and lateral branches. While in 2 sides, the superficial branches give off the medial branches and lateral branches with no big branches from the deep branches. There are branches of saphenous nerve and medial dorsal cutaneous nerve in the flap. All the flaps were survived. 8 cases were followed up for one months to one years. Good color, texture and function of the flaps were achieved.

CONCLUSIONSThe medial pedis composite flaps with saphenous nerve can repair tendo calcaneus and adjacent defects. It is a easy and safe procedure with reliable anatomy and good results.

Adolescent ; Adult ; Child ; Female ; Foot ; blood supply ; surgery ; Humans ; Male ; Peripheral Nerves ; anatomy & histology ; Surgical Flaps ; blood supply ; innervation ; Young Adult

OBJECTIVETo investigate the clinical application of reversed sural neurofasciocutaneous flaps in children.

METHODSFrom January 2002 to January 2007, 16 children patients with deep defect of foot and ankle were treated with reversed sural neurofasciocutaneous flaps. The size of the flaps ranged from 6.5 cm x 5.0 cm to 17 cm x 10 cm. The upper margin of the flaps reached the upper one-third of the leg in 10 cases, with 2 cases reaching the popliteal fossa and 1 case reaching 1.5 cm above the transverse line of popliteal fossa.

RESULTSThe flaps survived completely in 14 cases. There were partial necrosis at the distal end of flap in one case and superficial necrosis at the distal end of the flap in one case. The wounds were healed spontaneously after secondary suture and dressing change. The patients were followed up for 2 - 46 months with good aesthetic results.

CONCLUSIONSThe reverse sural neurofasciocutaneous flaps in children has a reliable survival area, which can reach the upper on -third of the leg until the transverse line of popliteal fossa. It is an ideal reconstructive method for deep defect of foot and ankle.

Ankle Injuries ; surgery ; Child ; Child, Preschool ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Skin Transplantation ; Sural Nerve ; blood supply ; transplantation ; Surgical Flaps ; blood supply