|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
D. Dorsal view of the same structures, with the rich venous arcade over
the bases of the toes. The short extensor to the great toe is shown crossing
the first metatarsal space, covering the dorsalis pedis artery and its venae
comitantes. This muscle should be cut early in the dissection to facilitate
the identification of the artery and its penetrating branch in the first
metatarsal space. This muscle can be cut long and used in the hand to anastomose
to the short extensor or be brought around to the palmar surface to strengthen
opposition of the transplanted toe.
A. The lateral incision of the skin island has been carried well back on the dorsal medial aspect of the foot, exposing the large saphenous vein. The short extensor has been cut, and the underlying dorsalis pedis artery and its venae comitantes have been mobilized from the dorsum of the foot distally into the toe. The proximal communicator at the base of the first metatarsal space is seen with a branch from the saphenous vein joining it. This communicating branch between the saphenous vein and the venae comitantes of the dorsalis pedis artery is a consistent anatomic finding and can often be used to locate this point of penetration of the artery.
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