Distal foot coverage with reverse dorsal pedal neurocutaneous flaps

Various types of neurocutaneous flaps have been used for extremity reconstructions. However, the application of this technique to the dorsum of the foot has not been reported previously. The aim of this article is to evaluate the attempts and clinical results from dorsal pedal neurocutaneous flap procedures. Harvesting of these flaps included the medial, intermediate and lateral dorsal cutaneous nerves, the deep peroneal nerve and the nutrient arteries of these nerves. The vascular anatomy of these flaps was studied before the clinical usage of the procedure. From 2003 to 2008, 30 patients with skin defects and bone exposure of the dorsum of the distal foot were treated with 39 dorsal pedal neurocutaneous flaps in our centre. The flaps in this series ranged from 3.5 to 7.0 cm in width and 4.0 to 10.0 cm in length. Totally, 35 flaps healed uneventfully. One showed partial loss at the distal edge, and three survived entirely following continuous massage. The postoperative contour of the flaps was acceptable. The reverse dorsal pedal neurocutaneous flap has proved effective and convenient for coverage of minor- to medium-sized defects in the distal foot.