Extensor Digitorum Brevis Muscle Flap Research Articles

The reverse flow extensor digitorum brevis flap for dorsal foot defects—A single center study

Defects on the dorsum of the foot remain a reconstructive challenge for plastic surgeons. There are very few pedicled flaps that have a reach up to the distal foot and those too with a threat of poor perfusion. Very often distal foot has to be resurfaced with free flap even with small defects. This study describes our experience with the reverse extensor digitorum brevis muscle (EDB) flap for small- to medium-sized defects on the dorsum of the foot. The study was conducted on 12 patients between February 2018 and March 2020 who presented with defects on the dorsum of the foot. The mean age of the patients was 30.8 years and the mean defect size was 20.17cm2. The EDB was applied on 10 male and 2 female subjects and resurfaced with a split thickness skin graft. The donor site was closed primarily. All flaps survived well. Two patients had small graft loss and 2 partial wound dehiscence of donor site, all of which healed on conservative treatment. Three patients had temporary sensory disturbance which resolved in few weeks. The reverse EDB flap is a reliable flap for the coverage of small- to medium-sized dorsal foot defects. The flap has the advantage of robust vascularity, expendable muscle with little donor site morbidity, an easy to learn technique, short operating time, and acceptable esthetic outcome, and it can be used as the primary option in cases of small to medium dorsal foot defects.

Extensor digitorum brevis muscle flap for lower extremity coverage in a context of posttraumatic sepsis

IntroductionTraumatic injuries to the distal quarter of the leg present a significant risk of skin necrosis and exposure of the underlying fracture site or the osteosynthesis material that often result in bone and joint infection. In the case of small or medium-sized bone exposure, local muscles may be one of the best options for lower extremity coverage. We describe our experience using the extensor digitorum brevis muscle flap in a context of posttraumatic bone and joint infection in fourteen patients. Our main objective was to assess the outcomes and the donor-site morbidity of the extensor digitorum brevis muscle flap. Materials and methodsA single-center retrospective study in a French reference center for bone and joint infection from 2014 to 2018 reviewed cases of traumatic injuries with skin complications and bone and joint infection that required an extensor digitorum brevis muscle flap coverage. Fourteen patients were evaluated for early and late complications, 11 men and three women with a mean age of 51.4±17.72 (19–71) years. Seven of these were open fractures and nine cases were pilon fractures. Donor-site morbidity was assessed in nine patients. ResultsEarly flap complications included two cases (14.2%) of hematoma, one case (7.1%) of partial necrosis and four cases (28.5%) of donor-site dehiscence. Late complications caused by persistent infection were found in two patients (14.2%), with one case (7.1%) of chronic osteoarthritis and one case (7.1%) of septic pseudarthrosis. From a functional and cosmetic point of view, eight patients (89%) were satisfied, to very satisfied. ConclusionExperience and a multidisciplinary approach are keys in providing an optimal treatment strategy for complex cases of bone and joint infection. The extensor digitorum brevis muscle is a reliable flap for small defects with underlying infection. Being made up of muscle tissue, this flap offers good resistance to infection and enables satisfactory distribution of antibiotics. Level of evidenceIV.

Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction.

Reconstruction of complex defects in the lower leg is a challenge. Although microvascular free tissue transfer is a popular technique, experience and available resources limit its use. Furthermore, free tissue transfer is not always required in the reconstruction of small lower leg defects, as many of them can be reconstructed with local alternatives such as an extensor digitorum brevis flap (EDB). Our aim was to describe our experience of the last 20 years with the EDB as a local muscle flap to cover small complex lower leg defects to establish its clinical feasibility and to document its associated complications. All adult patients who were operated with EDB flap reconstruction of the lower limb during 1997-2017 at the Department of Hand and Plastic Surgery, Linköping University Hospital, were included in this retrospective study. Of 64 patients operated, only 7 had total flap failure, and the rate of complete success was 73% (47/64). Most of the skin defects were associated with fractures or complications thereof and were located in the ankle region, the dorsum of the foot, and the distal third of tibia or even the proximal tibia. Defects in the malleolar region and coexisting cardiovascular condition were factors associated with flap loss (either partial or total). The pedicled EDB-flap has, in our hands, proved to be a versatile and safe reconstructive option in the reconstruction of small defects in the lower leg and foot. Long-time follow-up is, however, recommended.

Extensor digitorum brevis flap on the treatment of lower limb injuries.

OBJECTIVE: To describe our pioneer national experience with 11 patients with soft tissue defects in the distal 1/3 of the leg, ankle and forefoot treated with extensor digitorum brevis muscle flap (EDB). METHODS: Between November 2009 and July 2012 11 patients were operated with the flap technique. We operated nine men and two women aged between 10 and 66 years. The surgical indications were acute trauma in four patients and post-traumatic osteomyelitis in seven patients. The small defects were covered ranging from 3x3 to 6x3 cm. The patch was applied with proximal stalk in most cases. RESULTS: Complete healing and infectious cure were obtained in all cases, despite one loss. CONCLUSION: The EDB flap is a feasible and safe technique to repair foot, ankle and distal leg losses. Suffering, dehiscence and delayed healing of the EDB end flap donor area may, however, occur. L-shaped incisions should be avoided for muscle lifting. Level of Evidence IV, Case series.

Extensor Digitorum Brevis Muscle Flap: Modified Approach Preserving Extensor Retinaculum

Although numerous reconstructive options for covering defects over distal third of leg and dorsum of foot have been suggested, obtaining satisfactory cover remains difficult problem. Extensor digitorum brevis muscle flap as proximally or distally based island flap has been well described to be a promising alternative. Between 2004 and 2005, 10 defects over dorsum of foot and around malleoli were reconstructed with extensor digitorum brevis muscle flap. Six were proximally based and four were distally based flaps. Retrospectively, data were collected from these patients records like age, gender, type of injury, flap used, flap survival, complications, hospital stay, return to work. Mean follow-up period was 17.5 months (26-12 months). Of 10 flaps, one flap had failed (approximately 10%). Minor donor site problem presented in one case (10%). All patients returned to work after variable periods of rest (average 1(1/2) month). First web hypoesthesia was present only in two patients. This flap provides an excellent local option for small defects around ankle and over dorsum of foot. The advantages of this flap are its easy dissection, reliable blood supply. Disadvantages related to donor site can be minimized with careful technique.

Anatomic Reconstruction of a Chronically Unstable Calcaneocuboid Joint with Augmented Extensor Digitorum Brevis Muscle Flap: A New Method

Level of Evidence: V, Expert Opinion

Extensor digitorum brevis muscle flap using parallel incision

A single incision is generally used to dissect the extensor digitorum brevis (EDB) muscle flap. However, in addition to exposure difficulties, this single incision may cause problems at donor sites, since both the dorsalis pedis vascular bundle and the sinus tarsi branch of the lateral tarsal artery require careful dissection. Thus, we modified the approach by using two parallel longitudinal incisions to expose the dorsalis pedis vascular bundle and the sinus tarsi branch of the lateral tarsal artery separately. Using this modified parallel-incision EDB muscle flap, we were able to reduce the operation times and donor site skin complications.

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

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

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

Soft tissue defects of the foot and ankle region are difficult to treat, given the lack of local flaps. Some methods available are unreliable, multistaged, have significant donor-site morbidity, or are technically complex, requiring significant training and postoperative equipment or monitoring not available at all institutions. We report the largest experience using the extensor digitorum brevis muscle flap for foot and ankle reconstruction. The charts of 20 patients were retrospectively reviewed. Eighty-five percent of the wounds were successfully treated with this flap, with minimal donor-site morbidity. The extensor digitorum brevis muscle flap has minimal morbidity, is easy to elevate, does not require microsurgical skills, and can be performed at most institutions. The extensor digitorum brevis muscle flap is a practical option for wounds located at the foot and ankle region and should be considered in patients potentially requiring a free flap.

A recurrent foot ganglion managed with extensor digitorum brevis muscle flap coverage

The case of a 42-year-old woman with a persistent ganglion cyst of the dorsolateral aspect of the foot is presented. After multiple aspirations and 4 attempts at excision, the lesion degenerated into a painful, persistently draining wound with communication to the calcaneocuboid joint. The case was treated with dissection of the lesion to the joint, excision, and coverage of the defect with an extensor digitorum brevis muscle flap. The rationale for this surgical approach and the literature regarding recurrent ganglia are discussed.

Extensor Digitorum Brevis Free Flap: Anatomic Study and Further Clinical Applications

The extensor digitorum brevis muscle flap is reliable, safe, and can be used either as a pedicle or as a free flap with minimal donor site morbidity. To increase the existing knowledge of this flap and to establish further anatomic basis for the design and elevation of the extensor digitorum brevis flap, 26 specimens from 13 fresh cadavers were dissected under 3.5 × loupes. The lateral tarsal artery was found to be the main blood supply to the muscle. It has an average diameter of 1.83 ± 0.35 mm and a length of 1.89 ± 0.69 cm. The dorsalis pedis artery has, at the level of the lateral tarsal artery takeoff, a diameter of 3.25 ± 0.62 mm. From this point to the origin of the deep plantar branch, the dorsalis pedis artery has minimal branching, and the surgeon has available an artery homogeneous in diameter that is 6.77 ± 0.99 cm in length. Related neurovascular structures (anterior tibial artery and the venae comitantes, dorsalis pedis and first dorsal metatarsal artery, and deep peroneal nerve) were also studied. A safe and reliable harvesting technique and the “T interposed extensor digitorum brevis” technique for sparing the anterior tibial artery are presented, as are clinical case examples on the use of this flap as a flow-through, extensor digitorum brevis-vascularized nerve graft, a combined extensor digitorum brevis-deep peroneal nerve graft, and a bilobed extensor digitorum brevis-dorsalis pedis fasciosubcutaneous free flap. (Plast. Reconstr. Surg. 105: 1347, 2000.)

The extensor digitorum brevis muscle flap for the reconstruction of soft tissue defects in the lower limb

The use of the extensor digitorum brevis muscle as a local muscle island flap for the cover of soft tissue defects in the lower extremity is presented. The anatomy of the muscle, the blood supply, the elevation, and use of the extensor digitorum brevis muscle flap in the lower extremity are discussed. This flap offers a mean area of 27 cm2, which can cover large skin defects otherwise difficult to treat. A case of trauma to the medial malleolus is presented; this was treated successfully with the extensor digitoru brevis muscle flap.

The Extensor Digitorum Brevis Muscle Island Flap for Soft-Tissue Loss Around the Ankle

The extensor digitorum brevis muscle flap, which has already been suggested as a local flap for the foot, has been applied by us in 2 cases with excellent results. This flap, as with other muscle flaps, provides an excellent bed for the skin graft. Furthermore, because of its width, it allows for covering an area of skin loss 5 X 7 cm in size in areas that are difficult to cover by other reconstructive means. The arch of rotation of this flap allows for coverage of the lateromedial and posterior surfaces of the ankle with no functional loss at the donor site. The relative ease of elevating this flap presents a reasonable justification for its wider application as a single local procedure for skin problems around the ankle.