Reconstruction of post‐traumatic drop foot deformity by the chimeric deep inferior epigastric artery perforator free flap associated with a composite quadriceps osteotendinous graft

Dorsiflexor tendons are particularly exposed in crush injury of the foot. Anterior tibialis tendon defects may be responsible for a steppage gait and a drop foot deformity. Drop foot reconstruction is challenging because of the high risk of postoperative adhesions and functional sequelae. In this report, we present the results of the reconstruction of post‐injury anterior tibialis tendon defects with chimeric deep inferior epigatric artery perforator (DIEP) free flap associated with a quadriceps osteotendinous graft in two patients. Two men (32‐year‐old and 19‐year‐old) presented drop foot deformity with defect of the anterior tibialis tendon secondary to a crush injury. The sizes of the soft tissues defects at the foot dorsum were 24 cm × 8 cm and 20 cm × 8 cm, respectively. The quadriceps osteotendinous grafts were used to reconstruct the anterior tibialis tendon in both patients. The chimeric DIEP free flaps with skin paddles (24 cm × 8 cm and 20 cm × 8 cm) and rectus abdominis fascia (24 cm × 4 cm and 20 cm × 4 cm) were used for reconstruction. The skin component based on a musculocutaneous perforator was used for soft tissue reconstruction of the foot dorsum. The fascial component based on a second perforator was used to create a sliding surface around the osteotendinous graft. Postoperative course was uneventful. Rehabilitation lasted 3 months. The range of ankle movement was measured during 12 months. The first patient recovered 10 degree of dorsiflexion. The second patient recovered 25 degree of dorsiflexion. Walk recovery was satisfying in both patients. The single‐stage procedure using the chimeric DIEP free flap may be an option for post‐injury drop foot reanimation. Creating a sliding surface around a composite osteotendinous quadriceps graft with a vascularized fascial component avoid postoperative peritendinous adhesions. This technique may improve foot dorsiflexion and walk recovery. © 2015 Wiley Periodicals, Inc. Microsurgery 36:334–338, 2016.