Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 34:
Arteriogram and Doppler Preoperative Evaluation for Free Tissue Transfer
  Free Toe Transfers and Neurovascular Island Flaps of the Foot. In a recent study, 13 preoperative Doppler arteriograms were compared with intraoperative evaluation of 102 toe-to-hand transfers. There was a high correlation between preoperative Doppler, the arteriogram, and intraoperative anatomic findings. In 58% of those studied, the first metatarsal artery lay above the transverse metatarsal ligament. The authors concluded that arteriograms are necessary only when patients have had foot surgery or have an inconclusive Doppler examination (see Fig. 33-1).


Composite tissue transfers are used to reconstruct or replace deficits. The feasibility of the transfer depends on the adequacy of the arterial and venous system in the recipient area. The preoperative arteriogram or Doppler examination of that site is almost always indicated. Both preoperative arteriography and Doppler examinations assess the quality of the vessel that will receive the donor vessel, determine the exact location of the recipient vessel, outline precisely the vascular anatomy, and usually show all collateral circulation.

In the trauma patient with a single vessel to supply a distal extremity, a preoperative arteriogram assists in delineating the extent of injury and the status of other more proximal vessels. Rather than diverting the flow to the flap off the single vessel by an end-to-side anastomosis, it is frequently better to perform end-to-end anastomosis to a more proximal vessel using long vein grafts, thereby bringing increased blood supply to the traumatized distal extremity.


FIG. 34-01. The dorsalis pedis arterial pulse is followed by Doppler distally. If the signal disappears at the bases of the first and second metatarsal, the dominant blood supply to the first or second toe will be plantar.

FIG. 34-02. Drawing of a plantar-dominant foot.

FIG. 34-03. Arteriogram of a plantar-dominant foot. Note that the dominant plantar vessel crosses below the first metatarsal shaft making plantar vs dorsal dominance notable on AP arteriograms.

FIG. 34-04. If the Doppler signal can be followed distally, the blood supply to the first or second toe is dorsal-dominant.

FIG. 34-05. Drawing of a dorsal-dominant foot.

FIG. 34-06. Arteriogram of a dorsal-dominant foot. Note that the dominant vessel lies in the center of the 1st web space on AP arteriogram.


1. McLean, D.H., and Buncke, H.J.: Autotransplant of omentum to a large scalp defect with microsurgical revascularization. Plast. Reconstr. Surg. 49:266, 1972.

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