Technique tip: EDL-to-EHL double loop transfer for extensor hallucis longus reconstruction

Extensor hallucis longus tendon and soft‐tissue reconstruction with palmaris longus tendon included in a radial forearm free flap: A case report

“…It has been estimated that the EHL muscle contributes 15% of the dorsiflexion strength of the ankle, and injury or surgical excision of EHL tendon without reconstruction cause hallux dysfunction and results in a flexion deformity at interphalangeal joint (Bastías et al, ; Griffiths, ; Joseph & Barhorst, ; Kessler, ; Lipscomb & Kelly, ; Park et al, ; Pedreira et al, ; Robertson, Nutton, & Keating, ; Smith & Coughlin, ; Soucacos et al, ; Taylor & Townsend, ; Thordarson & Shean, ; Wong et al, ; Zielaskowski & Pontious, ). There is no consensus in the literature regarding the ideal reconstruction of EHL tendon after oncologic resection: most of the cases reported reconstructions of acute or chronic tendon rupture.…”

“…More recently, Bastías reported three cases of EHL reconstruction with EDL-to-EHL double loop transfer achieving an acceptable functional result (Bastías et al, 2019). However, none of these nonvascularized tendon transfer techniques is sufficient to reconstruct of combined tendon and soft tissues defects.…”

“…At latest follow-up, 12 months postoperatively, the patient showed an F I G U R E 1 After the excision of a myxoinflammatory fibroblastic sarcoma recurrence, the EHL tendon was sacrificed, leaving a 14 × 5 cm soft-tissue defect and 14-cm tendon gap. EHL, extensor hallucis longus F I G U R E 2 A 14 × 5 cm radial forearm flap with a 16-cm section of palmaris longus tendon including the investing deep fascia was harvested from the left forearm on a vascular pedicle It has been estimated that the EHL muscle contributes 15% of the dorsiflexion strength of the ankle, and injury or surgical excision of EHL tendon without reconstruction cause hallux dysfunction and results in a flexion deformity at interphalangeal joint (Bastías et al, 2019;Griffiths, 1965;Joseph & Barhorst, 2012;Kessler, 1973;Lipscomb & Kelly, 1955;Park et al, 2003;Pedreira et al, 2019;Robertson, Nutton, & Keating, 2006;Smith & Coughlin, 2008;Soucacos et al, 1992;Taylor & Townsend, 1979;Thordarson & Shean, 2005;Wong et al, 2014;Zielaskowski & Pontious, 2002). There is no consensus in the literature regarding the ideal reconstruction of EHL tendon after oncologic resection: most of the cases reported reconstructions of acute or chronic tendon rupture.…”

“…Extensor hallucis longus (EHL) excision without reconstruction could result in a flexion deformity of the toe at the interphalangeal joint, as described in neglected tendon lacerations (Thordarson & Shean, ). Few reports are available addressing EHL tendon reconstruction after oncologic resection, and there is no consensus in the literature regarding the ideal technique (Bastías, Cuchacovich, Schiff, Carcuro, & Pellegrini, ; Joseph & Barhorst, ; Lipscomb & Kelly, ; Park, Lee, & Sim, ; Pedreira, Calotta, & Deune, ; Smith & Coughlin, ; Taylor & Townsend, ; Wong, Daniel, & Raikin, ; Zielaskowski & Pontious, ). The use of a palmaris longus tendon included in a fasciocutaneous radial forearm free flap for reconstruction of the extremities has been firstly described by Soucacos et al in (Soucacos, Beris, Xenakis, Malizos, & Touliatos, ).…”

Reconstruction of the extensor hallucis longus with a hamstring tendon autograft: a systematic review

“…Some patients may present to a medical provider in a delayed fashion with a chronic injury, which cannot undergo direct repair secondary to tendon retraction and scar tissue formation (9,17,18) . For this situation, local tendon transfers or tendon reconstruction procedures using allograft or autograft have been described (6,17,(19)(20)(21)(22)(23)(24)(25)(26)(27) . The use of hamstring tendon (HT) autograft has been reported for various foot and ankle reconstruction surgeries with minimal donor site morbidity (28) .…”