Download THE EXTENSOR HALLUCIS BREVIS MUSCLE FLAP blood

BRIEF
532
THE
EXTENSOR
REPORTS
HALLUCIS
A. D. CROCKER,
We describe
a patient
exposing
an internal
with a medial
malleolar
fixation
device.
This
BREVIS
MUSCLE
FLAP
A. L. H. MOSS
skin defect
was successtarsal
fully treated
with a local extensor
hallucis
brevis muscle
flap based
on the dorsalis
pedis
vessels.
The flap is well
vasculanised,
easy to raise, thin and leaves
an acceptable
secondary
defect.
It can be extended
to include
the rest of
extensor
digitorum
brevis
if a larger
flap is required.
Case
report.
A 36-year-old
woman
sustained
a closed
fracture
of the distal
third of the left tibia and fibula in a
caving
accident.
Open
reduction
with primary
bone
grafting
was
the posterior
decided
that
debnidement
tibial
and dorsalis
a local
flap
should
the
extensor
applied
as
uneventfully
described
and the
plaster.
healed,
six months
an acceptable
After
with
Operative
made
flaps
technique.
pedis
be
hallucis
below.
patient
1st dorsal
artery
brevis
flap
The
wound
was mobilised
the flap remains
donor
site.
A longitudinal
stable
dorsal
was
healed
without
and
tendon
raised
is divided
distally
and
incision
the
is
Skin
the
musculoten-
unit
raised
together
with
the
dorsalis
As much
adjacent
EDB
as required
can
to increase
the
size
of the
flap.
1
Its origin
blood
pedis
also be
is then
to these muscles
is the dorsalis
pedis artery
tarsal
branch.
This, together
with its venae
supply
via its lateral
comitantes
well
superficial
peroneal
nerve.
The first dorsal
metatarsal
artery
is then identified
in the first web space and the
proximal
deep perforating
branch,
which
is ligated.
The
EHB
Fig.
motor
and
to
preferable
fasciocutaneous
Mathes
and
Nahai
small suction
drain.
Discussion.
The extensor
digitorum
sists of four slips (Fig. I), the most
often
termed
the extensor
hallucis
nal
Department
Bristol
BSI6
Correspondence
©
FRACS,
FRACS,
Locum
Senior
of Plastic
and
1LE. England.
to Mr
A.
Senior Registrar
Registrar
Reconstructive
L. H.
(EDB)
conof which
is
(EHB).
The
Surgery,
Frenchay
Moss.
1989 British
Editorial
Society
of Bone
030l-620X/89/3R08
$2.00
J Bone Joint Surg [Br] l989:71-B:532.
Hospital,
Joint
(1979)
deep
peroneal
nerve,
flaps
for
defects
with
higher
repairing
state
that
is is too
small
and has a small arc of rotation.
a much larger arc and we suggest
is suitable
for defects
diameter;
the flap will
region
without
difficulty.
of the malleoli
also reach
the
It may perhaps
for
Our
that it
up to 5 cm in
lateral
malleolar
be raised
even
after
splitting
the
extensor
retinaculum
and
it. The secondary
defect
consists
of a longitudi-
scar
dorsalis
(which
pedis
is an
flap)
advantage
and
there
over
is no
the
conventional
functional
deficit.
We would
like to thank
Mr R. W. Hiles for allowing
us to report on the
patient
under
his care.
No benefits
in any form
have
been
received
or will be received
from a commercial
party
related
directly
or indirectly
to the subject
of
this article.
Landi
REFERENCES
A, Soragni
0,
Monteleone
M. The extensor
digitorum
muscle
island
flap for soft-tissue
around
the ankle.
P/ast
Surg 1985;75;892-7.
Leitner
and
ofthe
exposed
internal
fixation
devices.
The
extensor
digitorum brevis has been previously
used as a microvascular
free flap in facial
re-animation
and has been described
previously
as a local muscle
flap (Leitner,
Gordon
and
Buncke
1985;
Landi,
Soragni
and
Monteleone
1985).
sharply
dissected
from
the calcaneum
and the dorsalis
pedis and its venae
comitantes
dissected
to a level that
allows
a comfortable
arc of rotation.
The
extensor
retinaculum
may
need
to be partly
released
to allow
tension-free
positioning.
The flap may then be tunnelled.
to the defect
and inset.
A split skin graft is then applied
primarily.
The secondary
defect
is closed
directly
over a
brevis
medial
brevis
branch
supplies
two branches
that enter the posterior
aspect of
the muscle
belly
from
its medial
side. The muscle
is
dispensible
functionally,
as extension
of the toes can be
maintained
by the long extensors.
It is generally
accepted
that
muscle
flaps
are
muscle
transposition
technique
allows
A. D. Crocker,
A. L. H. Moss,
metatarsal
vessels.
It was
used
and,
after
over the course
of the dorsalis
pedis
vessels.
are raised,
medially
and laterally,
preserving
dinous
vessels.
hallucis-
and internal
fixation
performed
at another
of the plaster
at three months
exposing
the distal plate and
indicated
antegrade
flow in
institution.
Upon
removal
skin necrosis
had occurred,
screws.
Doppler
ultrasound
Extensor
brevis
artery
Surgery
DW,
muscle
Mathes
St.
Gordon
L, Buncke
island
flap. P/ast
HJ. The extensor
digitorum
Reconst
Surg
1985:76:777-80.
SJ, Nahal
F. C/inica/
at/as ofmusc/e
Louis,
etc : CV Mosby
Co, 1979.
THE
JOURNAL
and
OF BONE
brevis
Reconsi
brevis
as a
muscu/ocutaneousfiaps.
AND
JOINT
SURGERY