First Dorsal Metatarsal Artery Flap for Coverage of Distal Foot Wounds: A Case Discussion and Narrative Review

Reconstruction of distal foot and toe wounds present a challenging problem, as defects in this area are often associated with exposed tendons and bones, making split skin grafts impossible in many cases. There is also a need for any flap to achieve a smooth and nonbulky contour to allow for wearing of footwear and acceptable esthetic results. The first dorsal metatarsal artery (FDMA) flap has been increasingly described as a functional and effective method of managing relatively small distal foot and toe defects. We present a case study of our patient who underwent FDMA flap coverage of a big toe dorsum wound, and we also present a review of the literature. Of the 13 papers and 46 cases in the published literature, all flaps survived. Authors report good functional outcomes, with patients regaining ambulation and fitting footwear owing to the flap's thin and pliable contour. Complications reported include 5 cases of superficial distal tip necrosis, all of which healed spontaneously. We conclude that the FDMA flap is a reliable, reproducible, and suitable coverage option for small distal foot, webspaces, and toe defects. They are relatively easy to perform and associated with good reported outcomes.