Extensor Digitorum Brevis Muscle Flap: New Refinements

Abstract

Two original operative techniques of raising the extensor digitorum brevis muscle flap are presented. These methods allow for covering distal foot defects that are difficult to cover by other reconstructive means. In the first technique, the flap is based on an extended distal pedicle supplied by the dorsal interosseous artery of the first intermetatarsal space. In the second technique, the flap receives its vascular supply from the medial tarsal artery; this procedure may be valuable when the vascular supply of the dorsalis pedis pedicle has been disrupted. To confirm the availability of these vascular pedicles, cadaver dissections were performed and proved that the extended pedicle dissection enhances the rotation arc of the flap. Four selective clinical cases, in which the flap was successfully used, are discussed. Advantages of these techniques, in reconstructing large defects in the distal foot, are delineated.

Extensor digitorum brevis flap on the treatment of lower limb injuries

“…From its description, few reports have been published in the literature 11 - 16 and only in 2003, Martinet et al ., 17 Chattar-Cora and Pederson 18 and Chateau et al 19 . published a significant number of cases, with respectively 15, 20 and 52 patients operated on this technique and with good results.…”

Coverage of defects over toes with distally based local flaps: A report of four cases

“…[1] When the wound involves the toes, the vascular pedicle based on the deep plantar branch is limited and the distal communication between the FDMA and the plantar system becomes invaluable in these cases. [414] Although the traditional reverse dorsal pedis flap can be designed to include the area over the extensor retinaculum and even extend proximally over the extensor retinaculum for 3 cm,[116] the FDMA flap is safely limited to below the level of the extensor retinaculum. [17]…”

“…The FDMA courses through the first intermetatarsal space distally in the subcutaneous tissue or deep to or within the first dorsal interosseous muscle. [4] It then passes dorsal to the transverse metatarsal ligament and divides into two dorsal digital arteries to the toes. It communicates with the plantar arterial network via the distal communicating artery.…”

Experience With the Extensor Digitorum Brevis Muscle Flap for Foot and Ankle Reconstruction

“…6,7,9,10,14,17,18 In a cadaveric study, Baltensperger et al 16 were able to demonstrate an arc of rotation slightly less than 30 cm above the ankle joint for the EBD. Although tempting, if other alternatives are available for middle and proximal third wounds of the leg, we believe that it may be prudent to use those alternatives before sacrificing a major vessel of the lower extremity to use the EDB flap.…”

“…This muscle's blood supply is based on the lateral tarsal artery and vein. Others have subsequently presented case reports with experience using the EBD flap for the treatment of ankle wounds, 6 and most recently case reports using this flap as a reverse flow flap for coverage of dorsal foot wounds have been published, [7][8][9][10] while Ghareeb 11 has used this flap based on the peroneal artery. Unlike its attempted uses in facial reanimation 12,13 and soft tissue and bony reconstruction about the hand, 14,15 its reported use in reconstructive foot surgery has been limited.…”