Blood supply to the second metatarsophalangeal joint—anatomical injection study and clinical correlation for free vascularised joint transfer

Background: Reconstruction of the injured/arthritic metacarpophalangeal joint remains challenging. Free vascularised joint transfer (VJT) using the second metatarsophalangeal joint (MTPJ) remains the gold standard, with an oblique osteotomy is usually performed to correct the natural hyperextended MTPJ during transfer. Surprisingly, few descriptions of the MTPJ arterial supply exist, despite reports of avascular necrosis of the MTP head following VJT. This study provides an up-to-date investigation of the second MTPJ blood supply. Methods: The anterior and posterior tibial arteries in three cadaveric feet were injected with an Indian ink-latex mass. The second toe was dissected in its entirety. A modified Spalteholz technique was then used to demonstrate the extraosseus and intraosseus blood supply of the metatarsal head. Results: Irrespective of arterial dominance within the first web space, the MT head was observed to receive a constant branch from the first dorsal metatarsal artery (FDMA) at a mean distance of 2.1 cm from the MTPJ. Variable articular branches were also observed to branch from the first/second plantar metatarsal arteries. Conclusions: This is the first formal injection study to identify the presence of a constant articular branch from the FDMA. During VJT dissection, better knowledge of the blood supply allows planning of osteotomy without compromising blood supply to the MT head. Level of Evidence: Not ratable. © 2016, Springer-Verlag Berlin Heidelberg.