Reverse Dorsalis Pedis Flap Based on the Distal Communicating Artery of the Dorsalis Pedis Artery for the Reconstruction of the Forefoot Defect

원위교통동맥 기저 역행성 족배피판을 이용한 전족부 결손의 재건

A 31-year-old female patient presented with a skin and soft tissue defect measuring $8{\times}6cm$ in size with exposure of the extensor hallucis longus tendon and the first metatarsal bone after metatarsal lengthening for brachymetatarsia. The defect was covered with a distally based dorsalis pedis flap based on the distal communicating branch of the dorsalis pedis artery. Secondary defect was covered by a split thickness skin graft. There was congestion of the flap tip after the operation; however, it was resolved using medical leeches and anti-coagulants. No necrosis or infection was encountered and the contour of the flap was satisfactory. There was no donor site morbidity. Reverse dorsalis pedis flap has not been commonly used due to the anatomical variation and uncertainty, which is different from the reverse radial forearm flap. However, when faced with the challenge of a moderate soft tissue defect of the distal forefoot, we believe that the reverse dorsalis pedis flap offers a good option with various advantages.