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

Published:April 22, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.082

      Summary

      Background

      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.

      Methods

      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 20.17 cm2. 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.

      Results

      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.

      Conclusion

      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.

      Keywords

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      References

        • Badgley C.E.
        Coalition of the calcaneus and navicular.
        Arch Surg. 1927; 15: 75-88
        • Fuson S.
        • Barrett M.
        Resectional arthroplasty treatment for calcaneonavicular coalition.
        J Foot Ankle Surg. 1998; 37: 11-15
        • Barfred T.
        • Reumert T.
        Myoplasty for covering exposed bone or joint on the lower leg.
        Acta Orthop Scand. 1973; 44: 532-538
        • O Brien B.M.
        Microvascular reconstructive surgery.
        Churchill Livingstone, New York1977
        • O Brien B.M.
        • Franklin J.D.
        • WA M.
        Cross-facial nerve grafts and micro-neurovascular free muscle transfer for long established facial palsy.
        Br J Plast Surg. 1980; 33: 202-215
        • Landi A.
        • Soragni O.
        • Monteleone M.
        The extensor digitorum brevis muscle island flap for soft-tissue loss around the ankle.
        Plast Reconstr Surg. 1985; 75: 892-897
        • Leitner D.W.
        • Gordon L.
        • Buncke H.J.
        The extensor digitorum brevis as a muscle island flap.
        Plast Reconstr Surg. 1985; 76: 777-780
        • Ismail T.I.
        The dorsalis pedis myofascial flap.
        Plast Reconstr Surg. 1990; 86: 573
        • Buncke H.J.
        • Hing D.N
        Extensor digitorum and hallucis brevis muscle transplantation and applica- tion as an Island muscle flap.
        in: Buncke H.J. Microsurgery: transplantation-replantation. Lea & Febiger, Philadel- phia1991: 507-520
        • Mandrekas A.D.
        • Zambacos G.J.
        • Grivas T.M.
        The extensor digitorum brevis muscle flap for the reconstruction of soft tissue defects in the lower limb.
        Eur J Plast Surg. 1995; 18: 82-84
        • Bakhach J.
        • Demiri E.
        • Chahidi N.
        • Baudet J.
        Extensor Digitorum Brevis muscle flap: New refinements.
        Plast Reconstr Surg. 1998; 102: 103-110
        • Martinet X.
        • Forli A.
        • Guinard D.
        • Corcella D.
        • Moutet F.
        Extensor digitorum muscle flap: Its position in ankle and foot coverage.
        Ann Chir Plast Esthet. 2003; 48 (Report of 15 cases): 159-166
        • Chattar-Cora D.
        • Pederson W.C.
        Experience with the extensor digitorum brevis muscle flap for foot and ankle reconstruction.
        Ann Plast Surg. 2006; 57: 289-294
        • Chateau F.
        • Chabas J.F.
        • Niddam J.
        • Guinard D.
        • Legré R.
        Use of extensor digi- torum brevis flap in routine reconstructive surgery of lower limbs. Report of more than 50 cases.
        Ann Chir Plast Esthet. 2012; 57: 600-605
      1. Hodges A. A-Z of plastic surgery: Oxford University Press, 2008.

        • Garrow A.P.
        • Papageorgiou A.C.
        • Silman A.J.
        • Thomas E.
        • Jayson M.I.
        • Macfarlane G.J.
        Development and validation of a questionnaire to assess disabling foot pain.
        Pain. Mar 2000; 85 (PMID: 10692609): 107-113https://doi.org/10.1016/s0304-3959(99)00263-8
        • Patzakis M.J.
        • Wilkins J.
        • Moore T.M.
        Use of antibiotics in open tibial fractures.
        Clin Orthop Relat Res. 1983; 178: 31-35
        • Attinger C.
        Soft tissue coverage for lower extremity trauma.
        Orthop Clin North Am. 1995; 26: 295-334
        • Hallock GG
        the first dorsal metatarsal artery perforator propeller flap.
        Ann Plast Surg. Jun 2016; 76: 684-687
        • Ger R.
        The management of chronic ulcers of dorsum of foot by muscle transposition and free skin grafting.
        Br Jr Plast Surg. 1997; 29: 199-204
        • Koul A.R.
        • Patil R.K.
        • Philip V.K.
        Coverage of defects over toes with distally based local flaps: A report of four cases.
        Indian J Plast Surg. 2008; 41: 62-66https://doi.org/10.4103/0970-0358.41114
        • Sakai S.
        A distally based island fi rst dorsal metatarsal artery fl ap for coverage of a distal plantar defect.
        Br J Plast Surg. 1993; 46: 480-482
        • Mathes S.J.
        • McCraw J.B.
        • Vasconez L.O.
        Muscle transposition fl aps for coverage of lower extremity defects: Anatomic considerations.
        Surg Clin North Am. 1974; 54: 1337-1354
        • Hirase Y.
        • Kojima T.
        • Fukumoto K.
        • Misu H.
        • Yamaguchi T
        Indication and practice of reverse flow extensor digitorum brevis muscle flap transfer.
        Ann Plast Surg. 2003; 51: 273-277
        • Torres L.R.
        • Paganelli P.M.
        • Dos Santos R.P.
        • et al.
        Extensor digi- torum brevis flap on the treatment of lower limb injuries.
        Acta Ortop Bras. 2014; 22: 86-89
        • Abdelrahman I.
        • Elmasry M.
        • Steinvall I.
        • Olofsson P.
        • Nettelblad H.
        • Zdolsek J.
        Versatility of the extensor digitorum brevis muscle flap in lower limb reconstruction.
        Plastic Reconstr Surg Global Open. 2018; (6. 1. 10.1097/GOX.0000000000002071)
        • del Piñal F.
        • Herrero F.
        Extensor digitorum brevis free flap: Anatomic study and further clinical applications.
        Plast Reconstr Surg. 2000; 105: 1347-1356
        • Koul A.R.
        • Patil R.K.
        • Philip V.
        Extensor digitorum brevis muscle flap: Modified approach preserving extensor retinaculum.
        J Trauma. Mar 2009; 66 (PMID: 19276762): 835-839https://doi.org/10.1097/TA.0b013e318165c835
        • McCraw J.B.
        • Furlow Jr., L.T.
        The dorsalis pedis arterialized flap: A clinical study.
        Plast Reconstr Surg. 1975; 2: 177-185
        • Robinson D.W.
        Microsurgical transfer of the dorsalis pedis neurovascular island flap.
        Br J Plast Surg. 1976; 29: 209-213
        • Smith A.A.
        • Arons J.A.
        • Reyes R.
        • Hegstad S.J.
        Distal foot coverage with a reverse dorsalis pedis flap.
        Ann Plast Surg. 1995; 34: 191-196
        • Pallua N.
        • Di Benedetto G.
        • Berger A.
        Forefoot reconstruction by reversed island flaps in diabetic patients.
        Plast Reconstr Surg. 2000; 106: 823-827