The First Dorsal Metatarsal Artery Perforator Flap: A Description and Anatomical Study

Background/Objectives: Soft-tissue defects surrounding the big toe can be a challenging problem for reconstructive surgeons. The first dorsal metatarsal artery (FDMtA) arises from the dorsalis pedis artery, which itself arises in front of the ankle joint from the anterior tibial artery. This study aimed to characterize the FDMtA cutaneous perforators (FDMtAPs) and evaluate the potential of a local pedicled perforator flap to cover a hallux soft-tissue defect. Methods: Nine feet from fresh cadavers were dissected to describe the FDMtAP anatomy. For each artery, we recorded the origin's position from the FDMtA, the proximal and distal diameters, and the artery's course, length, number, and type. We described the FDMtA perforator flap harvest and its application through a clinical case. Results: A mean of 3.67 ± 1.23 FDMtAPs were found from the nine dissected feet, with at least 2 perforators per foot. Around 88% were located between 0 and 4 cm along the axis at their origin from the FDMtA, with an area of around 8 cm² and a mean of 2.35 ± 0.36 cm long. The proximal diameter had a mean of 0.178 ± 0.037 mm and 0.110 ± 0.008 mm at the distal diameter. A pedicled flap was readily feasible for all dissections. The case described had satisfactory healing, correct functional, and aesthetic recovery at two months. Conclusions: The first dorsal metatarsal artery perforator flap seems to be a reliable and valuable solution for the hallux soft-tissue reconstruction, notably after the excision of acral melanoma.