The Medial Plantar Flap Vascularized by the Reverse Flow Lateral Plantar Artery: A Novel Variation through the Case of Aggressive Digital Papillary Adenocarcinoma of the Sole

Hayashi, Akira; Matsumura, Takashi; Horiguchi, Masaaki; Komuro, Yuzo; Itoh, Munenari; Idezuki, Takeo; Igarashi, Atsuyuki; Mizuno, Hiroshi

doi:10.1055/s-0032-1315769

Cited by 4 publications

(6 citation statements)

References 7 publications

(7 reference statements)

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“…These variant arterial supplies to foot and/or leg are of important anatomical significance and great clinical relevance, especially in plastic and vascular surgeries in an effort to reconstructing lower limb arteries or preparing viable muscle flaps [9][10][11][12][13]. The knowledge of these variations will definitely help reduce the risk of vascular trauma and unnecessary haemorrhage during lower limb surgery.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

et al. 2016

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Aims: Knowledge about branching pattern of the popliteal artery is very important in any clinical settings involving the anterior and posterior tibial arteries. This study aims to elucidate the anatomical variation patterns and common types of anterior tibial artery (ATA) and posterior tibial arteries (PTA) in the general population in China. Material and methods: Anatomical variations of ATA, PTA, and peroneal artery were evaluated with ultrasound in a total of 942 lower extremity arteries in 471 patients. Results: Three patterns of course in the PTA were ultrasonographically identified: 1) PTA1: normal anatomy with posterior tibial artery entering tarsal tunnel to perfuse the foot (91.5%), 2) PTA2: tibial artery agenetic, and replaced by communicating branches of peroneal artery entering tarsal tunnel above the medial malleolus to perfuse the foot (5.9%), and 3) PTA3: hypoplastic or aplastic posterior tibial artery communicating above the medial malleolus with thick branches of peroneal artery to form a common trunk entering into the tarsal tunnel (2.4%). In cases where ATA was hypoplastic or aplastic, thick branches of the peroneal artery replaced the anterior tibial artery to give rise to dorsalis pedis artery, with a total incidence of 3.2 % in patients, and were observed more commonly in females than in males. Hypoplastic or aplastic termini of ATA and PTA, with perfusion of the foot solely by the peroneal artery, was identified in 1 case. In another case, both communicating branches of the peroneal artery and PTA entered the tarsal tunnel to form lateral and medial plantar arteries.Conclusions: Anatomical variation of ATA and PTA is relatively common in the normal population. Caution should be exercised with these variations when preparing a peroneal artery vascular pedicle flap grafting. Ultrasound evaluation provides accurate and reliable information on the variations.

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Section: Introductionmentioning

confidence: 99%

Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

et al. 2016

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“… 5 The flap can be transposed as a propeller flap to cover the forefoot defect. However, there are concerns about unstable reverse arterial perfusion, reverse venous drainage, and vascular compromise with excessive tension to the vascular pedicle 4 when the flap needs to be transposed and extended more than expected.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 3 Especially in the distal forefoot, the stretched vessel is tightened, and the skin graft to the donor site presses on the vessel, precipitating venous congestion. 4 We reconstructed the lateral distal forefoot using a reverse medial plantar flap, which contains lateral plantar artery as the main pedicle, with a flow-through of the anterolateral thigh (ALT) flap covering the donor site to maintain physiological and stable blood flow.…”

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confidence: 99%

Sensate Reverse Medial Plantar Flap for Reliable Forefoot Reconstruction with Flow-through Anterolateral Thigh Flap

Murakami

Hori

Niimi

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: A reverse medial plantar flap is a major option for reconstructing the plantar forefoot. However, reconstruction of the distal forefoot stretches the vessels, causing tightness, and the skin graft to the donor site adds pressure to the vessel, precipitating venous congestion. We used a reverse medial plantar flap to reconstruct the lateral distal forefoot with a flow-through of the anterolateral thigh (ALT) flap for donor site coverage to maintain physiological and stable blood flow. A 74-year-old woman presented to our hospital with a 20-year history of left forefoot skin tumor. The tumor was resected, and histological examination revealed porocarcinoma in the cystic poroid hidradenoma. Additional excision was performed, and the defect area was covered with a biodegradable artificial dermis. The skin defect of the lateral distal plantar area was reconstructed with a reverse medial plantar flap with a reverse flow Y-V pedicle extension method, and the donor site was reconstructed with an ALT flap interposing the lateral circumflex femoral artery with the transected posterior tibial artery. The flap was completely engrafted without any complications, including arterial ischemia or venous congestion, during or after surgery. A distally based reverse medial plantar flap with a reverse flow Y-V pedicle extension method and flow-through of the ALT flap should be considered for the reconstruction of the lateral distal forefoot with a large defect. This method can maximize flap extension and maintain stable arterial inflow and venous drainage without the major complications of venous congestion.

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“…However, ADPA are characterized by aggressive local invasion, a high recurrence rate and an emerging metastatic potential . To date, surgical excision of the tumour lesion is the mainstay of treatment, comprising radical, wide local tumour excision, often including amputation of the affected digit . There are no approved treatment approaches for metastatic disease.…”

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confidence: 99%

Gene expression profiling in aggressive digital papillary adenocarcinoma sheds light on the architecture of a rare sweat gland carcinoma

et al. 2019

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Background Sweat gland carcinomas are rare cutaneous adnexal malignancies. Aggressive digital papillary adenocarcinoma (ADPA) represents a very rare subentity, thought to arise almost exclusively from the sweat glands of the fingers and toes. The aetiology of sweat gland carcinomas and ADPA is largely unknown. ADPAs are most likely driven by somatic mutations. However, somatic mutation patterns are largely unexplored, creating barriers to the development of effective therapeutic approaches to the treatment of ADPA. Objectives To investigate the transcriptome profile of ADPA using a sample of eight formalin-fixed, paraffin-embedded tissue samples of ADPA and healthy control tissue. Methods Transcriptome profiling was performed using the Affymetrix PrimeView Human Gene Expression Microarray and findings were validated via reverse transcription of RNA and real-time quantitative polymerase chain reaction. Results Transcriptome analyses showed increased tumour expression of 2266 genes, with significant involvement of cell cycle, ribosomal and crucial cancer pathways. Our results point to tumour overexpression of FGFR2 (P = 0Á001). Conclusions The results indicate the involvement of crucial oncogenic driver pathways, highlighting cell cycle and ribosomal pathways in the aetiology of ADPA. Suggested tumour overexpression of FGFR2 raises the hope that targeting the fibroblast growth factor (FGF)/FGF receptor axis might be a promising treatment for ADPA and probably for the overall group of sweat gland carcinomas. What's already known about this topic?• Aggressive digital papillary adenocarcinoma (ADPA) is a rare sporadic tumour, arising predominantly from sweat glands of fingers or toes.• ADPA is characterized by a local aggressive behaviour, a high recurrence rate and an emerging metastatic potential.• ADPA is most probably driven by somatic mutations. However, somatic mutation patterns are largely unexplored.• Knowledge of the biology of ADPA is almost completely lacking, creating barriers to the development of effective therapy strategies. Gene expression profiling in aggressive digital papillary adenocarcinoma, H.M. Surowy et al. 1153 a Paired t-test [cycle threshold (DCt) of tumour and control tissue]. b Not reliably detected in >1 ADPA tumours. Gene expression profiling in aggressive digital papillary adenocarcinoma, H.M. Surowy et al. 1155Fig 4.Differentially expressed genes (P < 0Á05, P detection < 0Á05, ratio < 0Á67 or > 1Á5) associated with the gene ontology (GO) 'angiogenesis' (GO:0001525) were subjected to cluster analysis and the resulting heatmaps and dendrograms show a clear separation of a tumour (T) and a normal tissue (N) cluster. Note: the official gene symbol for interleukin 8 is now CXCL8.

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The Medial Plantar Flap Vascularized by the Reverse Flow Lateral Plantar Artery: A Novel Variation through the Case of Aggressive Digital Papillary Adenocarcinoma of the Sole

Cited by 4 publications

References 7 publications

Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

Sensate Reverse Medial Plantar Flap for Reliable Forefoot Reconstruction with Flow-through Anterolateral Thigh Flap

Gene expression profiling in aggressive digital papillary adenocarcinoma sheds light on the architecture of a rare sweat gland carcinoma

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