Abstract:

Objective    To provide guides for transplantation of six kinds of little free flap harvested from toes by further exploring the course and diameter of four plantar metatarsal arteries and plantar digital arteries of the 1st, 2nd, 3rd and 4th toe at different plane, and apply these kinds of small-sized free flaps to repair subtotal defect of thumb and fingers.    Method    Twelve fresh foot specimens were dissected, observed and measured about four plantar metatarsal arteries and plantar digital arteries of the 1st, 2nd, 3rd and 4th toe. The transplantation of six kinds of small-sized free flaps harvested from toes was applied to repair subtotal defect of thumbs and fingers in 51 cases.    Result    The 1st, 2nd, 3rd and 4th plantar metatarsal artery originated from the deep plantar arterial arc，whose diameter was (1.24±0.36)，(1.16±0.32)，(1.10±0.27) and (1.09±0.29) mm，respectively，at the origin. The diameter of the fibular plantar digital artery of 1st toe was (1.09±0.21) mm at the initial site. The diameter of the tibial planter digital artery of the 2nd, 3rd and 4th toe was (0.98±0.24) mm, (0.85±0.18) mm, (0.82±0.17) mm at the initial site. All transplants survived. The period of following-up was from two to fifteen months postoperatively. All cases were graded as excellent as assessed using Criterion of Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery.    Conclusion    The four plantar metatarsal arteries were constant in their location and course without remarkable variation. The main blood supply of the small-sized free flap harvested from toes is from plantar digital artery. The main blood supply of the small-sized free flap harvested from 1st toe is from the fibular plantar digital artery, and that of the small free flap harvested from the 2nd, 3rd or 4th toe is from fibular planter digital artery. Transplantation of six kinds of small-sized free flaps harvested from toes is an optimal method for repairing subtotal defect of the thumb and fingers.

Key words:  Digit, Anatomy, Little free flap, Subtotal defect, Repair