The clinical importance of the relationship between the deep peroneal nerve and the dorsalis pedis artery on the dorsum of the foot.
BACKGROUND
The aim of this study was to describe the relationship between the deep peroneal nerve and the dorsalis pedis artery to help ensure a safer surgical approach in flap surgery.


METHODS
The dissection of 36 cadaver lower limbs was undertaken to describe the relationship of the deep peroneal nerve to the dorsalis pedis artery in the anterior tarsal tunnel and on the dorsum of the foot.


RESULTS
Four distinct relationships of the deep peroneal nerve to the dorsalis pedis artery were determined. In type 1 (36.1 percent), the artery was medial to the deep peroneal nerve in the tunnel and medial to the medial terminal branch below the tunnel on the dorsum of the foot. In type 2 (25.0 percent), the artery was medial to the deep peroneal nerve in the tunnel and lateral to the medial terminal branch below the tunnel on the dorsum of the foot. In type 3 (30.6 percent), the deep peroneal nerve and the artery were crossing over each other at multiple levels. In type 4 (8.3 percent), no medial terminal branch was observed. The artery was medial to the lateral terminal branch.


CONCLUSIONS
The dorsalis pedis neurovascular island flap contains both the dorsalis pedis artery and the deep peroneal nerve. Because the design of a neurovascular free flap requires detailed knowledge of the nerve and vascular supply, the data presented here will help surgeons during the surgical approaches to the foot and ankle.
İkiz
Zuhre Asl Aktan
ZAA
Bornova, İzmir, Turkey From the Department of Anatomy, Ege University Medicine Faculty.
Üçerler
Hülya
H
Uygur
Müjde
M
D001158:Arteries / Q000033:anatomy & histology*; D002102:Cadaver; D005528:Foot / Q000033:anatomy & histology / Q000098:blood supply*; D006801:Humans; D010543:Peroneal Nerve / Q000033:anatomy & histology*
Dong, J. S., Peng, Y. P., Zhang, Y. X., Lim, B. H., and Pho, R. W. H. Reverse anterior tibial artery flap for reconstruction of foot donor site. Plast. Reconstr. Surg. 112: 1604, 2003.
Lawrence, S. J., and Botte, M. J. The deep peroneal nerve in the foot and ankle: An anatomic study. Foot Ankle Int. 16: 724, 1995.
Standring, S. Gray’s Anatomy, 39th Ed., New York: Churchill Livingstone, 2005. P. 1505.
Cho, B. C., Lee, J. H., Weinzweig, N., and Baik, B. S. Use of the free innervated dorsalis pedis tendocutaneous flap in composite hand reconstruction. Ann. Plast. Surg. 40: 268, 1998.
Ohmori, K., and Harii, K. Free dorsalis pedis sensory flap to the hand, with microneurovascular anastomoses. Plast. Reconstr. Surg. 58: 547, 1976.
Daniel, R. K., Terzis, J., and Midgley, R. D. Restoration of sensation to an anesthetic hand by a free neurovascular flap from the foot. Plast. Reconstr. Surg. 57: 275, 1976.
Strauch, B., and Vasconez, L. O. Grabb’s Encyclopedia of Flaps, 1st Ed. Boston: Little, Brown, 1990. Pp. 1797–1800.
Tang, Y. B., and Chen, H. C. Dorsalis pedis flap with vascularised nerve graft for simultaneous reconstruction of palm and digital nerves. Br. J. Plast. Surg. 43: 494, 1990.
McCraw, M. J. B., and Furlow, L. T. The dorsalis pedis arterialized flap. Plast. Reconstr. Surg. 55: 177, 1975.
McPhee, J. R., Scher, L. A., Israeli, R., Ombrellino, M., Friedman, S. G., and Safa, T. K. Use of a local fasciocutaneous flap for treatment of exposed vascular grafts to the dorsalis pedis artery. J. Vasc. Surg. 38: 194, 2003.
Adani, R., Marcoccio, I., and Tarallo, L. Flap coverage of the dorsum of hand associated with extensor tendons injuries: A completely vascularized single-stage reconstruction. Microsurgery 23: 32, 2003.
Rab, M., Ebmer, J., and Dellon, A. L. Innervation of the sinus tarsi and implications for treating anterolateral ankle pain. Ann. Plast. Surg. 47: 500, 2001.