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.     

Painful extensor digitorum brevis manus muscle

Diagnosis was confirmed of 10 extensor digitorum brevis manus muscles in 7 patients. The muscle is located on the dorsum of the hand, just distal to the wrist. It is most prominent with the wrist flexed to 30 degrees and the fingers fully extended. We propose that pain in the extensor digitorum brevis manus muscle is due to compression of the muscle in the rigid fibro-osseous fourth dorsal compartment. Extensor retinacular release is the treatment of choice.     

Indication and practice of reverse flow extensor digitorum brevis muscle flap transfer

Although the pedicled extensor digitorum brevis (EDB) muscle flap is a versatile flap, there are not many reports about it. Furthermore, there are few reports about the reverse vascular flow EDB muscle flap. The lateral tarsal artery coming from the dorsalis pedis artery nourishes the EDB muscle flap. Cutting the dorsalis pedis artery proximal to the flap can elevate this flap with reverse vascular flow. The authors treated eight patients with a reverse vascular flow EDB muscle flap. All flaps survived, with minor repair in two cases. The follow-up period ranged from 4 months to 1 year. This flap has two pivot points for creating a reverse vascular flow pedicled flap and a large arc of rotation for coverage of the dorsal foot. The authors confirmed that this flap is very versatile for soft-tissue reconstruction of the distal dorsum of the foot. The blood supply is reliable and the operative procedure is not complicated and can be performed under regional anesthesia. With this flap, a well-vascularized bed can be prepared for coverage with a skin graft. The major disadvantage is numbness in the first web of the foot, but this does not cause problems in daily life.     

The conjoint extensor digitorum brevis muscle and dorsalis pedis osteocutaneous island flap

The privileged donor site of the foot is a well-recognized warehouse for spare parts particularly adaptable for composite tissue replacement of hand defects. Simultaneous microsurgical transfer of many of these parts is frequently performed. The ability to transfer these components on a common vascular leash as distinct yet dependent entities is another variation of this theme that enhances its flexibility. The extensor digitorum brevis muscle island and separate vascularized second metatarsal osteocutaneous flap represent one of many possible technical combinations of conjoined flaps based on the dorsalis pedis source vessel. The muscle portion of this flap provides any necessary soft tissue coverage. Sufficient dorsal foot skin is spared to allow primary closure of the foot, thereby minimizing morbidity in this notoriously difficult donor site.     

Extensor digitorum brevis muscle flap: its help in coverage of distal foot defects. Report of six cases

From January 1997 to march 2002, six extensor digitorum brevis muscle flaps have been used in four women and two men. Their ages were between five and 65-years-old. The defects were localised in the hallux in three cases, the dorsum of foot in one case, the other toes in one case and the external border of foot in one case. The defects were secondary to burn retraction in four cases, secondary to trauma in one case and secondary to osteomyelitis in another case. All the flaps were elevated on the distal dorsalis pedis artery with a retrograde flow. With an average of four years follow-up, all defects covered were very satisfying and there is no functional sequellae.     

The extended digitorum brevis muscle flap

The anatomy of the anterior tibial artery was studied in eight fresh cadavers. Consistently no major branches were found to the long toe extensor or anterior tibial muscle in the segment 15 cm preceding the lateral malleolus. This allowed the use of the extensor digitorum brevis muscle on a long anterior tibial vascular pedicle following release of the extensor retinaculum. The longer pedicle made this reliable muscle flap suitable for coverage of mid and lower tibial defects, in addition to ankle defects, as an alternative to free flaps. Its use is described in three complex cases.     

Naiplasty using a distally based ulnar finger dorsum flap

A case of reconstruction of the nail fold and the release of the scar contracture proximal to the nail matrix using a distally based ulnar finger dorsum flap and skin grafting is presented. An aesthetically fine nail fold was obtained, and the deformity of the nail plate was corrected by the relase of the scar contracture.     

Salvage of the distal foot using the distally based sural island flap

The authors describe their additional experience with the distally based sural island flap for reconstruction of the whole foot, including the forefoot area in 8 patients. The flap is vascularized by the lowermost perforating branches of the peroneal artery. The skin flap can be elevated, based on the lesser saphenous vein and its accompanying arteries, in all parts of the sural region. This modification allows a farther reach of the flap for coverage of the distal foot and sole. All flaps, innervated by the lateral sural cutaneous nerves, were able to provide protective sensation in the distal soles. In 7 patients the flaps survived completely, and only 1 patient had partial necrosis of the flap. The advantage of this flap is its constant and reliable blood supply without sacrifice of the major artery. Elevation of the flap is simple and rapid. This flap is a versatile alternative that should be considered prior to a free flap transfer.     

An avulsion fracture at the extensor digitorum brevis muscle origin

This paper attempts to familiarize the podiatrist with the pathologic entity of avulsion fracture at the extensor digitorum brevis muscle origin and its mechanism of injury, clinical presentation, and treatment. It can be seen on routine radiograms and the problem it presents is one of diagnosis rather than treatment.     

The versatility of the distally based peroneus brevis muscle flap in reconstructive surgery of the foot and lower leg

Soft tissue and bone defects of the lower leg, ankle, and heel region often require coverage by local or distant flaps. The authors successfully used the distally based peroneus brevis muscle flap for the treatment of 15 patients with osteomyelitis (n = 5), melanoma (n = 1), Achilles tendon defects (n = 6), posttraumatic bone defects (n = 2), and chronic diabetic heel ulcer (n = 1). The size of the defects ranged from 6 to 60 cm. All defects were covered successfully without major complications by the muscle flap. The distally based peroneus brevis muscle represents a very reliable flap for coverage of small and moderate defects of the medial and lateral malleolus, the Achilles tendon, and the heel area. This flap offers a convincing alternative for covering defects in the distal leg region and is often preferable to the use of free flaps because the surgery is rapidly performed and does not require microsurgical expertise.     

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.     

Applications of the extensor digitorum brevis muscle for soft tissue coverage

The extensor digitorum brevis muscle flap is valuable in covering defects of the distal tibia and both malleoli as an island muscle flap. It can also be used as a free vascularized muscle transfer for more distant problems. Case reports illustrating these applications are described, demonstrating the advantages of consistent anatomy, large vessel size, flap thinness, arc of rotation, and an inconspicuous donor site.     

Treatment of lateral ankle instability with transfer of the extensor digitorum brevis muscle

Ankle sprains are the most common injuries sustained during sports and physical exercise. Treatment is usually conservative because most of these injuries heal without consequence. However, some injuries may be followed by chronic lateral pain and instability, and surgical stabilization is sometimes necessary. In select cases, there is little or no residual ligament or scar tissue remaining for late reconstruction. Proximal transfer of the origin of the extensor digitorum brevis muscle as a substitute for deficient ligament tissue can be used in these difficult cases. During the years 1971 to 1992, 13 ankles in 10 patients underwent surgery using the proximal extensor digitorum brevis muscle transfer method. At follow-up, all the ankles manifested functional stability and were stable with no clinical drawer sign. All had a normal range of motion in the ankle joint but showed a desired decreased supination range of motion throughout the hindfoot and ankle. The functional Karlsson scores were 84.5 +/- 18.8 before injury, 26.4 +/- 18.7 before surgery, and 83.6 +/- 18.7 at follow-up. Thus, the extensor digitorum brevis muscle transfer seems to be a useful alternative method of long-term ankle stabilization in these difficult chronic case; the results correlate well with a few other studies using this method.     

Filling of a lateral pre-malleolar soft tissue defect with the extensor digitorum brevis flap and the abductor digiti minimi flap

The authors report the filling of a lateral pre-malleolar soft tissue defect after sub-talar arthrodesis. Four months after surgery the loss of substance measured 2,5 cm in depth, 3 cm diameter at the skin level and 5 cm diameter at the bone level. An autologous tricortical bone graft impacted in the sinus tarsi was also exposed. In this area of the body, soft tissue coverage is difficult because of the lake of local sub-cutaneus tissue and muscle. The authors used two locoregional pedicled flaps: the extensor digitorum brevis flap and the abductor digiti minimi flap. These transfers left a minimum of functional and aesthetic after-effects. The optimal coverage of the exposed structures allowed the patient to walk thirty days after surgery. The way to harvest these flaps, their advantages and disadvantages are detailed.     

Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects

Reconstruction of small defects in the distal portion of the foot has always been a difficult problem. A case involving a young man with a deep electric burn of the distal lateral side of the big toe, successfully treated with a distally based dorsalis pedis fasciocutaneous flap, is presented. The donor site area of the dorsum of the foot was grafted, and deambulation was reassumed three weeks later. Advantages, limits and anatomical consideration regarding the viability of the flap are also discussed.