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
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  A. B. The extensor digitorum brevis muscle is made up of four slips that originate from the lateral talocalcaneal ligament and inferolateral surface of the calcaneus. The most medial slip is the extensor hallucis brevis muscle, shown inserting into the base of the proximal phalanx laterally. The remaining three slips insert on the lateral aspects of the long extensor to the second, third, and fourth toes. The long extensors to the toes are superficial to the extensor digitorum brevis. The dorsalis pedis artery and venae comitantes give off the lateral tarsal artery and venae comitantes, which enter medially and deep to the extensor digitorum brevis muscle. The extensor hallucis brevis muscle crosses the first metatarsal space lying above the dorsalis pedis vessels. It provides a good landmark for locating these vessels. The deep peroneal nerve accompanies the dorsalis pedis vessels into the foot on their lateral aspect. The motor nerve from the deep peroneal nerve to the extensor digitorum brevis muscle enters the muscle with the lateral tarsal vessels. An S-shaped incision allows exposure of both the muscle bellies and the proximal dorsalis pedis vessels. The extensor hallucis brevis receives an independent blood supply, either from the lateral tarsal vessels or directly from the dorsalis pedis.


PLATE XXIII-2

A. The incision has been made, and the long extensors have been retracted to each side to provide exposure to the extensor digitorum brevis muscle slips. The superficial venous system will be encountered, and branches may require ligation with fine ties.

 


B. Once the distal tendon insertions have been isolated, they are cut. The ends should be tacked together and retracted as a group to prevent the individual slips from separating from one another.


C. The deep surface of the muscle is dissected free from the underlying structures. The lateral tarsal vessels and motor nerve will be seen at the juncture between the proximal and middle thirds of the muscle. The neurovascular pedicle is traced medially to the dorsalis pedis pedicle to be certain that the nutrient vessels are intact. The origin of the extensor digitorum brevis muscle is cut sharply, leaving the muscle connected by its pedicle. The dorsalis pedis vessels are ligated and cut distally. The proximal exposure is extended until an adequate pedicle length is achieved for rotation or microvas cular transplantation.


Clinical Cases

CASE 1

A man's dominant right hand was crushed in a food processing machine, causing a venous devascularization, carpal bone fractures, and extensor tendon lacerations. (From

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