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European Journal of Plastic Surgery

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01-10-2016 | Experimental Study

Blood supply to the second metatarsophalangeal joint—anatomical injection study and clinical correlation for free vascularised joint transfer

Authors: James Nott, Stephen J. Goldie, Wee Lam

Published in: European Journal of Plastic Surgery | Issue 5/2016

Abstract

Background

Reconstruction of the injured/arthritic metacarpophalangeal joint remains challenging. Free vascularised joint transfer (VJT) using the second metatarsophalangeal joint (MTPJ) remains the gold standard, with an oblique osteotomy is usually performed to correct the natural hyperextended MTPJ during transfer. Surprisingly, few descriptions of the MTPJ arterial supply exist, despite reports of avascular necrosis of the MTP head following VJT. This study provides an up-to-date investigation of the second MTPJ blood supply.

Methods

The anterior and posterior tibial arteries in three cadaveric feet were injected with an Indian ink-latex mass. The second toe was dissected in its entirety. A modified Spalteholz technique was then used to demonstrate the extraosseus and intraosseus blood supply of the metatarsal head.

Results

Irrespective of arterial dominance within the first web space, the MT head was observed to receive a constant branch from the first dorsal metatarsal artery (FDMA) at a mean distance of 2.1 cm from the MTPJ. Variable articular branches were also observed to branch from the first/second plantar metatarsal arteries.

Conclusions

This is the first formal injection study to identify the presence of a constant articular branch from the FDMA. During VJT dissection, better knowledge of the blood supply allows planning of osteotomy without compromising blood supply to the MT head.

Level of Evidence: Not ratable.

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Title: Blood supply to the second metatarsophalangeal joint—anatomical injection study and clinical correlation for free vascularised joint transfer
Authors: James Nott
Stephen J. Goldie
Wee Lam
Publication date: 01-10-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Plastic Surgery / Issue 5/2016
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-016-1215-5

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Blood supply to the second metatarsophalangeal joint—anatomical injection study and clinical correlation for free vascularised joint transfer

Abstract

Background

Methods

Results

Conclusions

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Abstract

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