The dorsalis pedis flap is most often used in hand reconstruction. In the head and neck, intraoral defects requiring thin and mobile skin may be reconstructed with this flap similarly to areas that may be reconstructed with a radial forearm flap. The skin also conforms well to external facial defects including those involving the nose, lip, and orbit. Limited segmental mandibular defects (< 6 cm) may be reconstructed using the second metatarsal bone. This bone may also be used as a cantilevered bone graft for nasal reconstruction. Replacement of the temporomandibular joint with the sec- g ond metatarsal joint is also described (65). The extensor digitorum brevis muscle g may be used for facial reanimation, although other flaps are more useful in this regard.

Neurovascular Anatomy %

The dorsalis pedis artery (an extension of the anterior tibial artery under the extensor retinaculum) and, the first dorsal metatarsal branch supply the flap. The venous |

drainage consists of a deep system (the venae comitantes that accompany the dorsa-lis pedis artery) and a superficial system in the subcutaneous substance of the flap that coalesce medially to form the long saphenous vein. The sensory supply to the

Figure 59 Surgical anatomy of the little-used dorsalis pedis flap. Note the vascular supply of this flap as the dorsalis pedis artery and vein.

skin is from terminal branches of the superficial peroneal nerve proximally and minor branches of the deep peroneal nerve distally. The motor supply to the extensor digitorum brevis is from tributaries of the deep peroneal nerve and its blood supply is from lateral tarsal branches of the dorsalis pedis artery.

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