Free transfer of the second toe combined with dorsalis pedis flap using microvascular technique for reconstruction of the thumb and other fingers.

The blood supply to the dorsum of the feet was studied in 100 cadaver feet specimens. The understanding of anatomical variation of branches of dorsalis pedis artery and its venous system are important in determining the success of the operation for free toe or dorsalis pedis flap transplantation. Three groups of fine branches of arterial system supplying the skin on the dorsum of the feet are classified; the central, the intermediate and the marginal groups. The central group is the dorminant blood supply to the dorsalis pedis skin flap. The first dorsal metatarsal artery which is a main branch of the dorsalis pedis artery remains to be dominant feeding artery to the second toe. From these cadaver specimens, three types of distribution are formulated, but with different percentages of distribution as compared with that of Gilbert's data. Seven consecutive cases of the second toe combined with dorsalis pedis flap transfer using microvascular technique for the reconstruction of thumb and other fingers are reported. The operation is designed to meet the demand of one stage reconstruction of the missing thumb or other fingers which are associated with surrounding soft tissue defects. Preparatory soft tissue repair by skin flap or tube flap is thus obviated.