Surgical Anatomy of Arteries Running in the Skin on Tuberosity of the Navicular Bone : Feeding arteries of medialis pedis flap

The medalis pedis flap reported by Masquelet et al in 1990 is supplied by the deep branch of medial plantar artery. This flap is composed of thin skin obtained from the medal part of the foot. Owing to this characteristic, it can be applied as an island flap to and around the heel or as a free flap to the digits. However, few detailed reports have been presented concerning the vascular anatomy of this flap. In the present study, we performed a cadavic study of the foot to confirm the course of the deep branch of the medial plantar artery and discuss the nomenclature. Materials and Methods: The course and ramifications of the deep branch of the medal plantar artery were investigated in 33 feet of 19 cadavers. Results: The deep branch of the medial plantar artery could be confirmed in all feet examined. Its course was classified into one of two patterns, i.e., 1. a single vessel ran in the vicinity of the scaphoid tubercle and then distally, or 2. Several small branches arose from the medial plantar artery and ran towards the scaphoid tubercle. These patterns were respectively called Typel and 2. The distance from the junction of the medial plantar artery to the origin of the deep branch was 8 to 25 mm (mean: 14 mm) and that from the origin of the deep branch to the scaphoid tubercle was 30 to 45 mm (mean: 35 mm). The diameter of the deep branch at its origin was 0.8 to 2.0 mm (mean: 1.2 mm). Discussion: There were differences in the origin and the diameter of the deep branch of the medial plantar artery, but there were no cadaver feet without this artery. Accordingly, medialis pedis flaps may be prepared without any particular problem. The average diameter of the deep branch was 1.2mm, which was larger than expected and was large enough for use as a free flap. In particular, this vessel may be useful in reconstructing the digits because its diameter was almost as large as that of the digital arteries The nomenclature of the nutrient vessel is still controversial. Although Masquelet described that the flap is based onthe deep branch of the medial plantar artery, Berteri et al and Lanfrey et al suggested that the medial plantar artery gives rise to two branches, medial and lateral branches, with the former diverging into two branches, superficial and deep branches. They concluded that the superficial branch of the medial branch is a nutrient vessel of the medialis pedis flap. We have confirmed that the nomenclature of the nutrient vessel of the medialis pedis flap should be called as recommended by Berteri et al and Lanfrey et al.