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Dorsalis Pedis Incision Vascular Surgery

Fig. 8.4. Dorsalis pedis flap Flap Harvesting

The patient is positioned supine with a tourniquet around the thigh. A distal incision is made for identification of the first dorsal metatarsal artery with subsequent retrograde dissection of the flap. The first dorsal metatarsal artery and branches of the deep peroneal nerve to the first web space are divided. The dissection continues from distal to proximal in a plane just deep to the deep peroneal nerve and first dorsal metatarsal artery. This plane is just above the peritenon of all the extensor tendons. The dissection is continued proximally up to the proximal head of the metatarsal. At that level the deep perforating branch of the dorsalis pedis artery is encountered. Make the medial incision of the flap and elevate the medial part of the flap with the greater saphenous vein and the dorsal venous arch included in the flap. Over the tarsal bones identify the dorsalis pedis artery. The deep branch is divided

Fig. 8.4. Dorsalis pedis flap Flap Harvesting

The patient is positioned supine with a tourniquet around the thigh. A distal incision is made for identification of the first dorsal metatarsal artery with subsequent retrograde dissection of the flap. The first dorsal metatarsal artery and branches of the deep peroneal nerve to the first web space are divided. The dissection continues from distal to proximal in a plane just deep to the deep peroneal nerve and first dorsal metatarsal artery. This plane is just above the peritenon of all the extensor tendons. The dissection is continued proximally up to the proximal head of the metatarsal. At that level the deep perforating branch of the dorsalis pedis artery is encountered. Make the medial incision of the flap and elevate the medial part of the flap with the greater saphenous vein and the dorsal venous arch included in the flap. Over the tarsal bones identify the dorsalis pedis artery. The deep branch is divided and the rest of the skin incised completely. With the upper incision completed, the extensor retinaculum is opened and the dorsalis pedis artery, its two venae comitantes and nerve are identified. The extensor hallucis brevis muscle is divided at the level of the extensor digitorum longus tendon to the second toe. Care should be taken to preserve the paritenon on the remaining tendons to provide a bed for the skin graft.

The flap can be used in the upper extremity to cover joints and tendons and in microvascular transplant of metatarsophalangeal joints in children.27

The donor site morbidity is of concern in this flap and it can include difficulties in primary healing with need for skin grafts, lymphedema, and hypertrophic scarring of the foot.28

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