Adipofascial turn-over flap based on perforators of the dorsalis pedis for resurfacing forefoot defects: an anatomic and clinical approach.

The aim of this study is to stress the possibility of harvesting a more sizable adipofascial turn-over flap based on the perforators of the dorsalis pedis artery than previously described. This flap can resurface the most distal dorsal defects of the forefoot, and the posttraumatic distal amputation of the forefoot, as a new indication. A detailed anatomic dissection of the flap was carried out on 12 fresh lower extremities together with injection study to determine flap pedicle location, flap dimensions, and its area of reach in the distal forefoot. The anatomic findings encouraged the author to elevate an adipofascial turn-over flap based on the perforators of the dorsalis pedis artery, where the largest flap size was 13 x 7 cm, and the base area to flap area ratio ranged from 1:3.5 to 1:6.5. An experience with 11 flaps was quite successful on eight patients with severe crushing and avulsion injuries of the forefoot and on three patients with unstable and ulcerating distal grafted amputated stumps secondary to trauma.