Retrograde dissection of the vascular pedicle in toe harvest.

A retrograde approach to dissection of the vascular pedicle in toe-to-hand transfer is presented, along with a simplified view of the vascular anatomy of the first web space. This approach has several advantages. First, the dominant vascular supply to the toe is elucidated early in the procedure, allowing for less unnecessary dissection of an inadequate pedicle. This also eliminates the need for preoperative arteriography. Furthermore, in cases where a lengthy pedicle is not required, retrograde dissection dispenses with harvest of a proximal vessel, which will not be needed for the transfer, and destructive dissection of the foot can be minimized.