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Lisfranc injuries
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
The plantar ligaments are better defined medially. The first cuneiform-metatarsal ligament is broad, and no plantar ligament exists between the middle cuneiform and 2nd metatarsal. The strongest, plantar ligament is the oblique ligament from the medial cuneiform to the 2nd and 3rd metatarsal bases (Figure 16.5). Recent studies have discovered a plantar ligament, the lateral Lisfranc ligament that spans from the 2nd to 5th metatarsal and this may explain the pattern of homolateral and divergent patterns of Lisfranc injury (9). The Lisfranc complex is also stabilised dynamically by muscle and tendons such as tibialis posterior, tibialis anterior and the plantar fascia. The dorsalis pedis artery and deep peroneal nerve cross the TMT complex deep to extensor hallucis brevis. The artery passes between the 1st and 2nd metatarsal and gives a branch to the deep plantar artery which forms the plantar arch. Avulsion of the artery can occur following injury.
Lower Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The anterior tibial artery crosses the ankle joint, and its name changes to dorsalis pedis artery that supplies the dorsum of the foot. It gives rise to the arcuate artery that in turn gives rise to the dorsal metatarsal arteries (Plate 5.9). The dorsalis pedis artery also gives rise to the lateral tarsal artery—which joins the lateral end of the arcuate artery to complete an arterial arch—and to the deep plantar artery—which passes between the 1st and 2nd metatarsal bones to enter the sole of the foot to form an anastomosis with the deep plantar arch formed mainly by the lateral plantar artery (Plate 5.16). The lateral plantar artery arises, together with the medial plantar artery, from the posterior tibial artery, and gives rise to the deep plantar arch that in turn gives rise to common and proper plantar digital arteries. Lastly, the fibular artery runs on the posterior side of the leg to give rise to the perforating branch of the fibular artery, which pierces the interosseus membrane just above the ankle joint to anastomose with the anterior tibial artery (Plate 5.11).
The Stomach (ST)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Dorsalis pedis artery: Supplies the muscles on the dorsum of the foot. The dorsalis pedis artery pierces the first dorsal interosseous muscle and becomes the deep plantar artery, which becomes part of the plantar arterial arch.
The superficial peroneal neurocutaneous flap: a cadaveric study
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Thepparat Kanchanathepsak, Katanyata Kunsook, Wasit Panoinont, Chinnawut Suriyonplengsaeng, Sorasak Suppaphol, Ittirat Watcharananan, Panithan Tuntiyatorn, Tulyapruek Tawonsawatruk
After the cadaver subject was prepared, the course of the SPN was drawn based on the anatomical pathway of this nerve, that passed anteroinferior between the peroneus longus and brevis, and the extensor digitorum longus muscles, before piercing the deep fascia in the distal third of the leg, and dividing into the MDCN and IDCN branches. The MDCN was located approximately half the distance from the medial malleolus to the lateral malleolus [17–19]. The axis of the flap was designed along the trajectory of SPN and MDCN. Subsequently, the skin paddle flap was outlined proximally by the midtarsal joint, and distally at the mid-length of the metatarsal bone. The lateral and medial margins were drawn at the most lateral and medial aspects of the dorsum of the foot. The 3 cm-wide flap pedicle, was outlined continuing from the proximal end of the skin flap, over the MDCN trajectory, to the anterior ankle joint line, thus ensuring the inclusion of paraneural vessels and superficial vein. The longitudinal skin incision was extended proximally to the ankle joint and distally to the first web space area. Before flap dissection, the SPN, MDCN, and anterior tibial artery (ATA) were identified proximal to the inferior extensor retinaculum, while the deep plantar artery was identified distal to the skin flap (Figure 2). The catheter was inserted into the ATA and the deep plantar artery was cut and ligated at the distal site. Blood clots in the vessels of ATA, the dorsalis pedis artery, and its perforators along the dorsum of the foot were removed by irrigation with 200 ml of warm normal saline solution (60 °C) via the ATA until leakage of normal saline was observed at the deep plantar artery [20,21]. To verify that the neurocutaneous artery could provide vascularity to the flap in antegrade flow, the proximally based pedicle flap was created before injecting methylene blue. The proximally based antegrade-flow SPNC flap was dissected based on the SPN and MDCN trajectory, using a surgical loupe with 2.5× magnification. While the incision was made starting at the distal end of the flap and followed along the medial and lateral borders, the MDCN and superficial vein were cut and ligated to be included in the flap. Due to the variation of the cutaneous nerve of the foot, the cutaneous branch of deep peroneal nerve also including in this flap. The dissection of the flap over the extensor hallucis longus and extensor digitorum longus tendons preserved the paratenon. The pedicle was subdermally dissected at the anterior ankle joint line, along the trajectory of the MDCN, with a 3 cm-wide flap axis. The flap and pedicle were elevated, along with the fascia, MDCN, and superficial vein.