The blood vessels and nerves of the dorsalis pedis flap

Although there are numerous reports on the anatomy of blood vessels and nerves in the feet of the Chinese (Chen, 1964; Weng et al., 1964; Chen, 1965; Zhang et al., 1979; Chen et al., 1980; Wu et al., 1980; Ling et al., 1981) discussions of their clinical and/or surgical significance are rare. The dorsa of the feet of 30 Chinese adults were dissected after injecting red-colored latex into the anterior tibial artery. The dorsalis pedis artery (DPA) was present in all cases, but two of the vessels took an unusual course. At the inferior border of the superior extensor retinaculum, the external diameters of the DPA and the great saphenous vein were 2.57 ± 0.09 mm and 3.66 ± 0.22 mm, respectively. The diameters of the vessels that constitute the pedicle of this free flap are large enough to allow anastomosis with those vessels at the recipient site. The dorsalis pedis veins connect with either the dorsal venous arch or the first metatarsal vein at a point 0.27–0.98 cm distal to the arch; therefore, to ensure a satisfactory venous return, a dorsalis pedis flap should be elevated 1 cm beyond the arch. The superficial peroneal nerve may supply only the medial half of the dorsum of the foot (27.58%); thus, reconstitution of the severed nerve would fail to restore sensation to the lateral part of the flap. A free flap from the first metatarsal space for covering small defects is recommended and is also based on a detailed knowledge of the neurovascular supply of this space.