Reconstruction of distal foot defects continues to be a challenging problem in plastic surgery. Skin grafting is the preferred choice owing to its simplicity but its use is limited by requiring a suitable wound bed. The reversed dorsalis pedis flap was first described by Ishikawa et al who identified inadequate venous outflow as the main risk to the flap.1 This led to sporadic reports of reversed dorsalis pedis flap applications despite advances in pre-operative imaging, surgical techniques and post-operative monitoring.
We present a case of soft tissue reconstruction with a reversed dorsalis pedis fasciocutaneous flap in a 17-year-old male who sustained a 900mm2 defect over his dorsal first MTPJ after falling off a motorcycle. The extensor hallux longus tendon was intact and there were no obvious fractures on xray. Intra-operatively, the patient was noted to have dorsomedial first MTPJ capsular and partial cartilage loss which made skin grafting unsuitable.
A pre-operative lower limb angiogram and doppler examination was performed to evaluate blood flow and dorsalis pedis artery positioning. The patient subsequently received a reversed dorsalis pedis fasciocutaneous flap 7-days after his initial wound debridement. The dorsalis pedis artery was mapped and the skin island was marked and designed. The flap included all fascial elements and extended from the lower margin of extensor retinaculum to the deep communicating branch which served as the pivot point to reach the defect. The patient was discharged on post-operative day 10 and continues to progress well in the post-operative period.
We described the application of the infrequently used reversed dorsalis pedis flap which can be a viable option in providing like-for-like soft tissue reconstruction for small- to medium-sized distal dorsal foot defects.