The free sensory flap promises the restoration of protective sensation in weight-bearing regions, the creation of pressure sensors for paraplegics, and perhaps tactile gnosis for sensory-depleted hands.
Of the free sensory flaps, the dorsalis pedis flap is thinner than the other flaps and provides a good texture match on the hand and has well-padded soft tissue. Also the dorsalis pedis flap has a long neurovascular pedicle and the external diamater of the dorsalis pedis artery is more than two mm, making anastomoses easier.
I have performed 20 cases of dorsalis pedis flap dissection in Korean cadaver and presented the detailed anatomical relationships between the blood vessels and the surrounding structures.
1) In two of the 20 cases, the extensor hallucis longus tendon and the dorsalis pedis artery cross at a point distal to the extensor retinaculum, so that about half of the proximal portion of the dorsalis pedis artery on the tarsal bones travels beneath the extensor hallucis longus. In such cases it is difficult to raise a flap containing the medial tarsal artery, which usually branches off a direct cutaneous terminal branch.
2) In 16 cases of the 20 cases, the lateral tarsal artery is originated in the upper liplf of the dorsalis pedis artery between the extensor retinaculumu and deep branch of the dorsalis pedis artery. In 15 cases of the 18 cases, the_ medial tarsal artery is originated in the middle one third of the dorsalis pedis artery between the extensor retinaculum. and deep branch of the dorsalis pedis artery.
3) In 2 cases of the 20 cases, the lateral tarsal artery is originated in the lower half of the dorsalis pedis artery between the extensor retinaculum and deep branch of the dorsalis pedis artery. In 3 cases of the 20 cases, the medial tarsal artery is originated just below the extensc_ retinaculum.
4) In 3 cases of the 20 cases, the medial tarsal artery is very small and a arcuate artery and aneighbouring cutaneous terminal branch are more prominant than the medial tarsal artery.
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