Few options exist for the resurfacing of web-space and small soft tissue defects of the dorsum of the distal foot. The study examines the anatomy of the second to fourth dorsal metatarsal arteries in 16 fresh frozen cadavers to determine if the anatomy correlates to that in the hand, permitting the design of local flaps based on perforators of these vessels. A clinical case is also presented, illustrating the efficacy of such a perforator-based flap.Sixteen Asian cadaveric lower limbs were used for this study. The specimens were prepared with latex dye injection. Dissection under loupe magnification was carried out to determine the position and caliber of the cutaneous perforators from the dorsal metatarsal arteries, and the spread of the latex dye in the skin from these cutaneous perforators. One clinical case illustration of this perforator-based flap for distal foot defect resurfacing is presented.In our cadaveric study, each second to fourth dorsal metatarsal artery had between 2 and 5 cutaneous perforators with calibers of 0.5 to 0.7 mm in diameter. The most distal cutaneous perforator was present consistently, always arising between the heads of the respective metatarsals.In conclusion, the vascular anatomy of the second to fourth dorsal metatarsal arteries is similar to that in the hand, thus allowing for the design of reliable perforator-based flaps for distal foot resurfacing.

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Facial fractures occur commonly as a result of blunt trauma from road traffic accidents, assaults, and sporting injuries. Orbital floor fractures form a significant proportion of these and when large enough, the defect often requires surgical reconstruction of the floor to prevent orbital content herniation. Here, we present a case of a 28-yearold gentleman, who sustained an orbital floor fracture from a soccer-related injury. The resulting floor defect was surgically repaired using an osteomesh that was hand-cut to size. He developed delayed enophthalmos and entrapment of the inferior rectus muscle due to early resorption of the osteomesh, requiring revision surgery. KEYWORDS: Accelerated osteomesh resorption, orbital floor implant, orbital floor fractureFacial fractures form a significant bulk of the craniofacial trauma patient load in our center. This is due to a high volume of road traffic accident and workplace accident cases being sent to the emergency department here. A considerable number of these facial injuries include orbital floor fractures which may also be associated with orbital floor defects and the resultant herniation of orbital contents. The relief of the herniated contents, be it orbital fat or recti musculature, and the concomitant reconstruction of the orbital floor defect can be a challenging proposition.Here, we present a case report of a 28-year-old gentleman who was referred to our department after sustaining blunt orbital trauma to his right eye during a soccer game. His initial presentation was that of right periorbital swelling and pain. Clinical examination showed a right periorbital haematoma, decreased upward gaze of his right eye and diplopia on upward gaze.A CT scan of his orbits was performed, and blowout fractures of his medial wall and orbital floor were noted with resultant herniation of orbital fat and the right inferior rectus muscle (Fig. 1). He was brought to the operating theater and the herniated orbital contents were elevated out from the orbital floor defect; the 1 Â 1 cm orbital floor defect was reconstructed with a 1.5 Â 1.5 cm bioabsorbable Osteomesh that was fashioned to size. The Osteomesh implant was placed over the floor defect and was not anchored; the periosteum was closed over the implant. The forced duction test performed was normal. An on-table decision was made by the consultant-in-charge not to fix the medial wall defect. On postoperative day 1, he was noted to have complete resolution of his diplopia and the upward movement of his right eye was near full. He was discharged well and subsequently seen in the outpatient clinic.

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