Blood supply to the second metatarsophalangeal
joint—anatomical injection study and clinical correlation for free
vascularised joint transfer
Received: 17 April 2016 /Accepted: 8 June 2016 / Published online: 24 June 2016
Springer-Verlag Berlin Heidelberg 2016
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 ca-
daveric 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 dis-
tance of 2.1 cm from the MTPJ. Variable articular branches
were also observed to branch from the first/second plantar
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.
Keywords Metatarsal phalangeal joint
The human hand exemplifies one of the most complex biome-
chanical systems in the body. Its tactile and proprioceptive ca-
pacity allows humans to manipulate their environments .
Fundamental to the hand’s functionality are the joints of the
fingers and thumb. Whilst being able to move smoothly through
a normal range of motion, the joints must be able to resist the
lateral force vectors generated during pinch and grasp functions.
The metacarpophalangeal (MCPJ) joint is susceptible to inju-
ry and arthritic degeneration, yet most current treatment options
fall short of desired functional outcome . In order to restore
function in a severely affected joint, the preferred method is a free
vascularized joint transfer (VJT) using the second MTP joint,
with an oblique osteotomy to correct the hyperextended
metatarsophalangeal joint (MTPJ). This remains the gold stan-
dard due to its growth potential, stability and acceptable appear-
ance following autotransplantation [2, 3]. However, the success-
fulness of the procedure is dependent on the donor vessels se-
lected, with preservation of the epiphyseal vessels desirable, to
avoid avascular necrosis and gain an overall successful outcome.
The blood supply to the second metatarsus has been
well documented and classified by several authors [4–6].
Nevertheless, it has been noted that a few studies have
detailed the vascular pattern of the second MTPJ,
James Nott and Stephen J. Goldie were joint first authors
* Stephen J. Goldie
Department of Anatomy, University of Edinburgh, Scotland, UK
Department of Plastic Surgery, St John’s Hospital, Howden Road
West, Livingston, EH54 6PP Scotland, UK
Eur J Plast Surg (2016) 39:331–334