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

Ji-Young Kang; Mi-Young Eo; Hoon Myoung; Suk-Keun Lee; Jong-Ho Lee; Soung-Min Kim

doi:10.5125/jkaoms.2011.37.3.184

Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(3) > 1032465

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Kang, Eo, Myoung, Lee, Lee, and Kim: Anatomical review of dorsalis pedis artery flap for the oral cavity reconstruction

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(3):184-194.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.3.184

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

Ji-Young Kang¹, Mi-Young Eo¹, Hoon Myoung¹, Suk-Keun Lee², Jong-Ho Lee¹, Soung-Min Kim¹

¹Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul

²Department of Oral Pathology, College of Dentistry, Gangnung-Wonju National University, Gangneung, Korea

Jong-Ho Lee Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University 28, Yeongeon-dong, Jongno-gu, Seoul, 110-768, Korea TEL: +82-2-2072-2630 FAX: +82-2-766-4948 E-mail: leejongh@snu.ac.kr

Received 9 January 2011 Revised 16 May 2011 Accepted 2 June 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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

References

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Fig. 1.

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

Fig. 2.

Arterial systems of the dorsum of left foot.

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)

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)

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)

Fig. 6.

Cross sectional view through the left metatarsus.

Fig. 7.

Muscles and tendons of the dorsum of foot.

Fig. 8.

Muscle and tendon marking with different suture materials.

Fig. 9.

Cutaneous nerves and veins of the dorsum of left foot.

Table 1.

Korean translational language of anatomical muscles, vessels and nerves in the dorsal foot lesion³⁷

Abductor digiti minimi muscle	소지외전근	Lateral tarsal artery	외측족근동맥
Abductor hallucis muscle	무지외전근	Lateral marginal vein	외측연정맥
Adductor hallucis muscle	무지내전근	Long plantar ligament	장족저인대
Adductor hallucis muscle, oblique head	무지내전근 사두	Lumbrical muscle	충양근
Anterior lateral malleolar artery	전외과동맥	Medial calcaneal branch	내측종골지
Anterior medial malleolar artery	전내과동맥	Medial dorsal cutanenous nerve	내배측피신경
Anterior tibial artery	전경골동맥	Medial malleolar network	내과동맥망
Arcuate artery	궁상동맥	Medial malleolus	내과
Articular branches of deep peroneal nerve	심비골신경관절지	Medial plantar nerve	내척측신경
Calcaneocuboidal joint	종입방관절	Medial sural cutaneous nerve	내측비복피신경
Common plantar digital nerve	총족측지신경	Medial tarsal artery	내측족근동맥
Communicating vein	교통정맥	Medial marginal vein	내측연정맥
Cuboideonavicular ligament	입방주인대	Muscular branches of deep peroneal nerve	심비골신경근지
Cutaneous branches of lateral plantar nerve	외측족저신경 피지	Navicular bone	주상골
Cutaneous branches of medial plantar nerve	내측족저신경 피지	Opponens digiti minimi muscle	소지대립근
Distal communication artery	원심교통동맥	Perforator	천공지
Deep branch of lateral plantar nerve	외측족저신경 심지	Perforating branch of peroneal artery	비골동맥 관통지
Deep peroneal nerve	심비골신경	Peroneus tertius muscle	제3비골근
Deep plantar branch	심족저지	Plantar aponeurosis	척측건막
Deep transverse metatarsal ligament	심부가로중족인대	Plantar digital arteries	척측지동맥
Dorsal artery of foot	족배측동맥	Plantar fascia	척측근막
Dorsal pedis artery	족배동맥	Plantar interosseous muscle	척측골간근
Dorsal digital artery	배측지동맥	Plantar metatarsal artery	척측중족동맥
Dorsal digital aponeurosis	배측지건막	Plantar metatarsal vein	척측중족정맥
Dorsal digital cutaneous nerve	족배지피신경	Posterior tibial artery	후경골동맥
Dorsal digital nerve of foot	배측지신경	Proper digital plantar artery	고유족저지동맥
Dorsal digital vein of foot	배측지정맥	Proper plantar digital nerve	고유족저지신경
Dorsal fascia of foot	족배근막	Quadratus plantae muscle	족저방형근
Dorsal interosseous muscle	배측골간근	Saphenous nerve	복재신경
Dorsal metatarsal artery	배측중족동맥	Small saphenous vein	소복재정맥
Dorsal metatarsal vein of foot	배측중족정맥	Superficial branch of lateral plantar nerve	외측족저신경 천지
Dorsal vein of foot	족배측정맥	Superficial lamina	천엽
Extensor digitorum brevis muscle	단지신근	Superficial peroneal nerve	표재비골신경
Extensor digitorum longus muscle	장지신근	Synovial sheath	활막건초
Extensor hallucis brevis muscle	단무지신근	Talocalcaveonavicular joint	거종주관절
Extensor hallucis longus muscle	장무지신근	Talonavicular ligament	거주인대
External marginal vein	외연정맥	Tendon of flexor digitorum brevis muscle	단지굴근건
First dorsal metatarsal artery	제1배측중족동맥	Tendon of flexor digitorum longus muscle	장지굴근건
First plantar interosseous muscle	제1척측골간근	Tendon of flexor hallucis longus muscle	장무지굴근
First planter metatarsal artery	제1척측중족동맥	Tendon of peroneus longus muscle	장비골근건
Flexor digiti minimi brevis muscle	단소지굴근	Tendon sheath of peroneus longus muscle	장비골근건초
Flexor digitorum brevis muscle	단지굴근	Tendon, extensor hallucis brevis muscle	단무지신근건
Flexor hallucis brevis muscle	단무지굴근	Tendon, extensor hallucis longus muscle	장무지신근건
Flexor retinaculum	굴근지대	Tendon, peroneus brevis muscle	단비골근건
Great saphenous vein	대복재정맥	Tendon, peroneus tertius muscle	제3비골근건
Head of talus	거골두	Tendon, tibialis anterior muscle	전경골근건
Inferior extensor retinaculum	하신근지대	Tendon of extensor digitorum longus muscle	장지신근건
Inferior peroneal retinaculum	하비골근지대	Tendon of tibialis posterior muscle	후경골근건
Intermediate dorsal cutaneous nerve	중족배피신경	Tendon, extensor digitorum brevis muscle	단지신근건
Lateral dorsal cutaneous nerve	외배측피신경	Tendon, extensor digitorum longus muscle	장지신근건
Lateral malleolus	외과	Transverse metatarsal ligament	가로중족인대
Lateral mallolar network	외과동맥망	Venous arch of dorsum of foot	족배측정맥궁
Lateral plantar nerve	외측족저신경

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