SLR - July 2014 - Jarna Rathod

Extensor Digitorum Brevis Flap on the Treatment of Lower Limb Injuries.

Reference: Torres LR, Paganelli PM, Santos RPN, Targa WHC, Fernandes TD, Mattar Junior R. Extensor Digitorum Brevis Flap on the Treatment of Lower Limb Injuries. Acta Ortop Bras. 2014;22(2):86-9.

Scientific Literature Review

Reviewed By: Jarna Rathod, DPM
Residency Program: North Shore- LIJ Forest Hills Hospital, NY

Podiatric Relevance: Wounds of the foot and ankle are the most complex area of coverage for reconstruction of lower limbs. Healing these wounds is a challenge all podiatric surgeons face. The presence of terminal vascularization, atrophic skin, bony prominences and small muscle mass are some of the reasons for this fact. The use of skin biologic agents may not be enough in closing these wounds and surgical reconstruction may be warranted. As foot and ankle surgeons, we should work hand in hand with plastic surgeons to devise a wound closure protocol using flap techniques. The purpose of this study is to use EDB as a skin muscle flap to cover defects after surgical treatment of chronic osteomyelitis in the foot, ankle and distal leg.

Methods: This was a retrospective review of 11 patients, nine men and two women, who were operated on utilizing the EDB flap technique. Seven patients underwent flap reconstruction for post traumatic osteomyelitis and four patients trauma related. Two flaps were retrograde to cover forefoot defects with ligature of the anterior tibial artery.  Nine flaps were anterograde to cover medial aspects of distal leg, and lateral surfaces of the ankle. Post-surgical evaluation included flap viability, healing of chronic infection, donor site dehiscence, and healing of skin defect. 

Results: All patients had at least one year follow up. Ten of the eleven flaps were viable, the unviable flap was lost. Of the viable flaps, complete healing of the skin defect was noted with cure of the osteomyelitis with no recurrence. Dehiscence of the donor site was noted in five of the eleven patients, four progressed to wound closure with outpatient treatment. In the one patient, tendon and bone was exposed, thus a reverse sural flap was necessary. For the patient with total flap loss, a reverse flow sural chimeric flap was performed. The authors believe the flap loss was likely caused by vascular damage during dissection.

Conclusions: The results of this study suggest that the EDB flap technique can be an effective method for management of wounds in the foot ankle and distal leg. Surgical complications of this flap technique can be minimized with careful incision planning (rectilinear vs longitudinal incisions). This technique can serve our patients well in the chronic, non-healing wounds where conservative measures have failed.  

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