Direct visualization of arterial anatomy during toe harvest dissections: clinical and radiological correlations.

The arterial patterns seen during 57 clinical dissections during toe transfers were divided into four types: (1) type A: a large first dorsal metatarsal artery and present plantar vessel (27 patients, 47 percent); (2) type B: a smaller first dorsal metatarsal artery within the interosseous muscle and an equal-sized plantar vessel (17 patients, 30 percent); (3) type C: a small, interosseous first dorsal metatarsal artery and dominant plantar vessel (8 patients, 14 percent); and (4) type D: an absent first dorsal metatarsal artery (5 patients, 9 percent). A modified and more expeditious toe harvest used the early identification of the vascular pattern through the first webspace followed by a retrograde dissection. The use of a meticulous surgical technique and multiple arterial anastomoses is advocated. Preoperative angiography of the foot is no longer routine and is now used selectively for trauma, cold injuries, or congenital anomalies. All 57 toe transfers (single or multiple) were successful; three were reexplored successfully for arterial insufficiency. A clinical correlation of arterial patterns was made between the angiograms obtained on 33 of these 57 patients and on 65 adult and pediatric patients without intrinsic vascular disease of the lower limb. Contrast reached the foot and toes faster through the posterior tibial artery and plantar arch in the majority of feet studied. Like the ulnar artery in the forearm and hand, the posterior tibial artery is the dominant conduit to the foot and ankle and, through the plantar arch, the major arterial system to the toes.