title: Arcus venosus dorsalis pedis: morphological considerations for use in superficial palmar arch reconstruction.
abstract: OBJECTIVE
  To report the branching patterns, vessel diameters, and location of the valves in the arcus venosus dorsalis pedis (AVDP) as a graft option for use in superficial palmar arch reconstruction after mutilating hand injuries.
  
  
  METHODS
  We dissected 10 cadaveric feet and measured vessel diameters, recorded number of branches, and located valves within the tibial, middle, and fibular thirds of the system. We used retrograde india ink injection to locate valves.
  
  
  RESULTS
  The AVDP branching pattern was grossly different from side to side in the 4 cadavers with bilateral feet available. Mean flat diameters were 4.7, 2.9, and 2.1 mm in the tibial, middle, and fibular thirds of the arch, respectively. There was a mean of 1.7 valves (range, 1-4 valves) in the tibial third, 1.5 valves (range 0-4 valves) in the middle third, and 0 valves in the fibular third. There was an average of 3.4 branches off the middle third with a mean branch diameter of 2.1 mm. In 65% of these branches, valves were within 1 cm distal to the main arch. The direction of flow within the middle third was from fibular to tibial.
  
  
  CONCLUSIONS
  Valves were commonly found within the middle and tibial thirds of the AVDP and within branches just distal to bifurcations. By contrast, the fibular third of the AVDP contained no valves. Valvular anatomy suggests that the direction of flow within the middle third was from fibular to tibial direction.
  
  
  CONCLUSIONS
  The AVDP is morphologically similar to the palmar arch. When rendering valves within the AVDP incompetent, attention should be paid not just to the main arch itself, but also to branches off the AVDP. The fibular and middle thirds of the AVDP can safely be used for palmar arch reconstruction without blockage of flow owing to valves. The branches off the middle third must be used within a few millimeters of their takeoff to avoid valves.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: John J
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ruta
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: John R
authors.initials: JR
authors.lastname: Lien
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Alex
authors.initials: A
authors.lastname: Brunfeldt
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Lawton
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI. Electronic address: kozer@umich.edu.
authors.forename: Kagan
authors.initials: K
authors.lastname: Ozer
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D004210:Dissection; D005260:Female; D005528:Foot / Q000098:blood supply*; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012501:Saphenous Vein / Q000033:anatomy & histology*; D013524:Surgical Flaps; D055422:Venous Valves / Q000033:anatomy & histology*
keywords: Arcus venosus dorsalis pedis; dorsal foot vein; palmar arch reconstruction; saphenous vein; vein diameter