Reverse first dorsal metatarsal artery flap for reconstruction of the distal foot

A method for reconstruction of soft tissue defects of the distal foot, web spaces, and toes using the reverse first dorsal metatarsal artery flap is presented. This flap is supplied by minute cutaneous branches of the first dorsal metatarsal artery and can be extended to the territory of the dorsalis pedis artery. We have applied this flap to 11 patients since 1987. Superficial tip necrosis occurred in 3 flaps among 8 extended ones, however, they healed spontaneously and satisfactory results were obtained in all patients. Two other reverse flow flaps based on the second, and the third and fourth dorsal metatarsal arteries, respectively, have also been applied. The versatility and pitfalls of reverse dorsal metatarsal artery flaps are discussed.