Document Detail

Arcus Venosus Dorsalis Pedis: Morphological Considerations for Use in Superficial Palmar Arch Reconstruction.
MedLine Citation:
PMID:  25262338     Owner:  NLM     Status:  Publisher    
PURPOSE: To report the branching patterns, vessel diameters, and location of the valves in the arcus venosus dorsalis pedis (AVDP) as a graft option for use in superficial palmar arch reconstruction after mutilating hand injuries.
METHODS: We dissected 10 cadaveric feet and measured vessel diameters, recorded number of branches, and located valves within the tibial, middle, and fibular thirds of the system. We used retrograde india ink injection to locate valves.
RESULTS: The AVDP branching pattern was grossly different from side to side in the 4 cadavers with bilateral feet available. Mean flat diameters were 4.7, 2.9, and 2.1 mm in the tibial, middle, and fibular thirds of the arch, respectively. There was a mean of 1.7 valves (range, 1-4 valves) in the tibial third, 1.5 valves (range 0-4 valves) in the middle third, and 0 valves in the fibular third. There was an average of 3.4 branches off the middle third with a mean branch diameter of 2.1 mm. In 65% of these branches, valves were within 1 cm distal to the main arch. The direction of flow within the middle third was from fibular to tibial.
CONCLUSIONS: Valves were commonly found within the middle and tibial thirds of the AVDP and within branches just distal to bifurcations. By contrast, the fibular third of the AVDP contained no valves. Valvular anatomy suggests that the direction of flow within the middle third was from fibular to tibial direction.
CLINICAL RELEVANCE: The AVDP is morphologically similar to the palmar arch. When rendering valves within the AVDP incompetent, attention should be paid not just to the main arch itself, but also to branches off the AVDP. The fibular and middle thirds of the AVDP can safely be used for palmar arch reconstruction without blockage of flow owing to valves. The branches off the middle third must be used within a few millimeters of their takeoff to avoid valves.
John J Lee; David J Ruta; John R Lien; Alex Brunfeldt; Jeffrey N Lawton; Kagan Ozer
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-9-24
Journal Detail:
Title:  The Journal of hand surgery     Volume:  -     ISSN:  1531-6564     ISO Abbreviation:  J Hand Surg Am     Publication Date:  2014 Sep 
Date Detail:
Created Date:  2014-9-28     Completed Date:  -     Revised Date:  2014-9-30    
Medline Journal Info:
Nlm Unique ID:  7609631     Medline TA:  J Hand Surg Am     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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