Download The Clinical Importance of the Relationship between the Deep

The Clinical Importance of the Relationship between the Deep Peroneal Nerve and the Dorsalis
Pedis Artery on the Dorsum of the Foot
Reference:
Ikez, Z., Ucerler, H., Uygur, M. (2007). The clinical importance of the relationship between the deep peroneal nerve and the
dorsalis pedis artery on the dorsum of the foot. Plastic and Reconstructive Surgery, 120(3), 690-696.
Scientific Literature Review
Reviewed by: Kirstyn Caldwell, DPM
Residency Program: University of Pittsburgh Medical Center - South Side, Pittsburg, PA
Podiatric Relevance:
This article describes the anatomical relationship of the deep peroneal nerve (DPN) and dorsalis pedis artery
(DPA) in regards to the dorsalis pedis free flap, which offers good cosmesis for use in hand and facial
reconstruction. The results and illustrations provided will aid in the surgical planning and approach of foot and
ankle surgery.
Methods:
36 limbs (18 formalin-fixed cadavers) were dissected to map the course of the dorsalis pedis artery and the deep
peroneal nerve. The limbs were dissected deep to the inferior extensor retinaculum in the area of the anterior
tarsal tunnel; then carried out distal and proximal. None of the limbs had evidence of prior foot or ankle surgery.
Results:
The dorsalis pedis artery and deep peroneal nerve were found to track along 4 different routes. In Type 1 (36.1%)
the DPA was medial to the DPN in the tarsal tunnel and medial on the dorsum of the foot (bilateral in four
cadavers). The DPA was medial to the DPN in the tunnel and lateral on the dorsum of the foot in Type 2 (25%),
one bilateral cadaver. Type 3 (30.6%) was further classified to types a, b and c based on each pattern of crossing
at multiple levels. Type 4 (8.3%) had no medial terminal branch of the DPN and the DPA coursed lateral to the
DPN lateral terminal branch (bilateral in one cadaver.)
Conclusions:
This article provides evidence of variance in the relationship of neurovasculature on the dorsum of the foot. Type
3 relates a higher chance of entrapment. In the event of harvesting an unsuitable DP free flap, the contralateral
limb maybe used as it may represent a different pattern (61.1%).