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Anatomical Classification of the First Dorsal Metatarsal Artery and Its Clinical Application

Background: Vascularized tissue transfer pedicled with the first dorsal metatarsal artery is commonly used in the microsurgical reconstruction of tissue defect. However, there are great anatomical variations of the artery. In this study, the authors classified the artery based on its origin (from where it arises), branches, and course. The significance of this classification system related to harvesting a first dorsal metatarsal artery–based tissue transfer is also discussed. Methods: Fresh tissue dissection (n = 48) and cast specimens (n = 30) were studied. Three-dimensional reconstruction (n = 5) was performed based on the computed tomography angiogram of the adult feet. Ultrasound color Doppler imaging was performed on 340 feet. The anatomy of first dorsal metatarsal artery was also studied in patients (n = 148) who had surgery on the first web space. Results: The intramuscular type of the artery described by Gilbert was not found in any of the study specimens. The most common type was found in the space between the dorsal interosseous muscle and the first metatarsal. The authors thus propose a new classification system for the first dorsal metatarsal artery: the arises (origin), branch, and course (ABC) classification system. Conclusion: The arises (origin), branch, and course classification system can help a surgeon to better understand the anatomical variations of the first dorsal metatarsal artery and harvest vascularized tissues based on the artery.