title: Anatomic basis and clinical application of the distally based medialis pedis flaps.
abstract: BACKGROUND
  Soft-tissue defects of the forefoot are difficult to cover adequately, particularly, although multiple options for reconstruction are available. This study especially focused on the vascularization of the medial side of the foot and the determination of the contribution of the nutrient vessels to medialis pedis flap viability.
  
  
  METHODS
  Thirty cadavers were available for this anatomical study. Microdissection was conducted under a microscope, and details of the course and distribution and the communication of the first plantar metatarsal artery with the fascial vascular network of the medial side of the foot were recorded. Clinically, six cases of soft-tissue defects at the forefoot region were reconstructed with distally based medialis pedis flap.
  
  
  RESULTS
  The perforator of the first plantar metatarsal artery pierces in the superficial fascia of the medial aspect of the foot 2.2 ± 0.7 cm proximal to the first metatarsophalangeal joint, vascularize the skin of the medial plantar region. The anatomical study showed that the vasculature pattern could roughly be classified into two types. In terms of clinical application, all flaps completely survived, and one patient had partial loss of skin graft.
  
  
  CONCLUSIONS
  The perforators of the medialis pedis flap are presented constant. The forefoot region can be repaired by the distally based medialis pedis flap on the perforator of the medial plantar artery of the hallux or the first plantar metatarsal artery perforator with medial plantar vein, medial plantar cutaneous nerve and nutrient vessels.
authors.affiliation: Department of Head and Neck Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.|Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.|Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Dajiang
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Hand and Foot Surgery, Yiwu Central Hospital, Zhejiang, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Comparative Medicine, General Hospital of People's Liberation Army Nanjing District, Fujian Medical University, Fuzhou, 350108, China.
authors.forename: Zedong
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Comparative Medicine, General Hospital of People's Liberation Army Nanjing District, Fujian Medical University, Fuzhou, 350108, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Comparative Medicine, General Hospital of People's Liberation Army Nanjing District, Fujian Medical University, Fuzhou, 350108, China.
authors.forename: Tianquan
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Comparative Medicine, General Hospital of People's Liberation Army Nanjing District, Fujian Medical University, Fuzhou, 350108, China. hepingzheng111@163.com.
authors.forename: Heping
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China. chunlinhoupro@163.com.
authors.forename: Chunlin
authors.initials: C
authors.lastname: Hou
mesh_terms: D000328:Adult; D002102:Cadaver; D005205:Fascia / Q000098:blood supply; D005545:Forefoot, Human / Q000033:anatomy & histology* / Q000601:surgery*; D006214:Hallux / Q000098:blood supply / Q000294:innervation; D006801:Humans; D008297:Male; D008684:Metatarsus / Q000098:blood supply / Q000294:innervation; D042282:Microdissection; D008853:Microscopy; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016909:Tibial Arteries / Q000033:anatomy & histology; D013979:Tibial Nerve / Q000033:anatomy & histology; D014680:Veins / Q000033:anatomy & histology; D055815:Young Adult
keywords: Forefoot reconstruction; Medial plantar artery of the hallux; The first plantar metatarsal artery