Dorsal Metatarsal Artery Perforator (DMtAP) flap Reconstruction of the Foot – A Review

Abstract

The dorsal metatarsal artery perforator (DMtAP) flap is a relatively new flap in the reconstructive armamentarium. Our understanding has only recently increased with data from cadaveric dissections, which have increased our understanding of the DMtAP system of the forefoot. Sporadic reports in the literature have been published regarding its various uses for defects around the forefoot. This review aims to summarize the reports and results thus far in the literature and bring together the anatomical evidence of DMtAPs in the forefoot. We also demonstrate our experience in raising a DMtAP flap and its potential use for reconstruction of the forefoot after skin cancer surgery. This is a versatile and reliable flap.

Ortho‐oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft‐tissue defects after oncologic resections

“…One‐hundred‐fourteen full‐text articles were assessed for eligibility. Seventy of these were excluded and the remaining forty‐four have been divided based on type of technique reported: local flaps (Liu et al, 2014; Masquelet et al, 1992; Nguyen et al, 2023; Ring et al, 2016; Woo et al, 2022; Zelken & Lin, 2016), free flaps (Akdag et al, 2018; Battiston et al, 2015; Calotta et al, 2018; Cherubino et al, 2020; Colterjohn et al, 1997; He et al, 2022; Kim et al, 2021; Kozusko et al, 2019; Medina 3rd et al, 2014; Musharafieh et al, 2001; Namdar et al, 2010; Nosrati et al, 2012; Periasamy et al, 2023; Sailon et al, 2009; Sayyed et al, 2022; Ulusal et al, 2005; Yu et al, 2021), perforator flaps (D'Arpa et al, 2014; Ellabban et al, 2020; Khan et al, 2020; Kwon et al, 2021; Lee et al, 2017; Li et al, 2021; Lin et al, 2021; Pignatti et al, 2011; Ring et al, 2016; Toia et al, 2017), skin grafts (Asif et al, 2018; Kang et al, 2019; Leclère & Casoli, 2016; Schneider et al, 2009; Shimizu & Kishi, 2012) and free bone (fibula) or osteocutaneous transfer (de Boer et al, 1990; El‐Gammal et al, 2002; Han et al, 1992; Toma et al, 2007).…”

“…These flaps have shown to be effective in the reconstruction of various foot defects, including those resulting from oncologic conditions (Lin et al, 2021). The most commonly used free perforator flap for foot reconstruction is the thoracodorsal artery perforator (TDAP) flap (Khan et al, 2020). However, defects involving the toes have been successfully reconstructed using the superficial circumflex iliac artery perforator (SCIP) flap, while other subunits were reconstructed using TDAP flaps (Kwon et al, 2021).…”

Utilization of the Free Fibular Flap for First Metatarsal Reconstruction

“…For small wounds of the forefoot, local graft options focusing on restoring blood flow have been described, especially involving the dorsal metatarsal artery flap. 2,4,9 Dusseldorp et al described a method of resecting a portion from the proximal second metatarsal head and fixating it to the proximal first phalanx, demonstrating that the dorsal metatarsal arteries and the plantar dorsal communicating arteries are a viable option for reconstruction. 9 The current literature also describes other options for bone and soft tissue reconstruction for the metatarsals, such as parascapular flaps, iliac flaps, and second metatarsal transfers.…”

“…1 There are a variety of reconstructive techniques that have demonstrated efficacy in repairing metatarsal defects, including the dorsal metatarsal artery perforator flap, free dorsal toe flap based on the lateral dorsal digital artery, and the pedicled fibula flap. [2][3][4] The pedicled fibula flap has been shown to be useful by not only minimizing anastomotic complications but also in situations where there are severe defects of the foot. 4 Furthermore, studies such as the one conducted by Lykoudis et al have determined that reconstruction of the midfoot may be performed in a single stage operation with the potential use of a free fibular osteocutaneous flap, and has led to limited postoperative complications.…”