Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 23:
Extensor Digitorum and Hallucis Brevis Muscle Transplantation and Application as an Island Muscle Flap
  The superficial dissection requires ligation of branches of the superficial saphenous system. Retraction of the tendons of the long extensors of the toes exposes the tendons of the extensor digitorum brevis inserting on the lateral aspect of the medial four toes. These tendons should be cut, retracted, and tacked together as a group to prevent the avulsion of one slip from the others. The connective tissue attachments of the muscle to the underlying tarsal bones are not dense but require careful dissection to preserve the lateral tarsal pedicle on the deep side of the muscle. Once the vascular structures are identified, they are traced medially and proximally to ensure that they are branches of the dorsalis pedis artery and venae comitantes. The proximal origin of the muscle is then sharply divided. The dorsalis pedis vessels are isolated distal to the take-off of the lateral tarsal vessels, ligated, and transected. If the motor nerve is not required, it is transected after it leaves the deep peroneal nerve. Otherwise, it is dissected proximally and split off the desired length. The dorsalis pedis artery and venae comitantes are dissected free, cutting through the inferior extensor retinaculum, if necessary to obtain more pedicle length. Once the recipient site is ready the pedicle is cut and the muscle moved in place.

While the muscle is being revascularized, the donor site is closed primarily by another team. A small Penrose drain is used to prevent any hematoma beneath the dorsal foot flaps. The wound is dressed with a compressive dressing, and the foot elevated continously for 2 weeks.


Operative Sequence

PLATE XXIII-1. Anatomy

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