|| Hing, D.N., Buncke, H.J., and Alpert, B.S.: Applications of the extensor digitorum brevis muscle for soft tissue coverage. Ann. Plast. Surg. 19:530, 1987.)
23-01. The dorsal injury has divided dorsal veins and both wrists
and digital extensors. A triangular, radially based flap lies over the
EPL tendon. Clinically, the hand exhibited venous congestion.
FIG. 23-02. X ray shows dislocation through the midcarpal row, and fracture of the capitate reduced and pinned.
FIG. 23-03. X ray of reduction and pinning.
FIG. 23-04. All extensor tendons were repaired. Multiple vein grafts were performed to restore venous outflow. A dorsal fasciotomy was skin-grafted.
FIG. 23-05. The radially based skin flap, however, was lost over the following 2 weeks, exposing the EPL.
FIG. 23-06. The extensor digitorum brevis muscle was chosen for vascular coverage of this small area. The vascular anatomy and incision are outlined on the foot.
FIG. 23-07. The lateral tarsal vessels cross the deep surface of the muscle slips of the extensor digitorum brevis between the proximal and middle thirds. The muscle is still attached by the vascular pedicle.
FIG. 23-08. The vascular anastomoses have been performed between the doralis pedis and radial vessels. The four muscle slips have been fanned and inset over the dorsal extensor tendons and could have been used to bridge tendon defects, if present.
FIG. 23-09. A meshed, split-thickness skin graft was placed on the muscle surface.
FIG. 23-10. Over one year later, the patient had excellent extension of the EPL tendon and digital extensors. The muscle with skin graft is soft and supple.
An adolescent girl suffered an open tibial fracture proximal to the medial malleolus in an auto accident. After fracture reduction and wound closure, the leg was immobilized in a cast. The closure broke down, exposing the fracture site in the distal third of the tibia. (From Hing, D.N., Buncke, H.J., and Alpert, B.S.: Applications of the extensor digitorum
brevis muscle for soft tissue coverage. Ann. Plast. Surg. 19:530, 1987.)
FIG. 23-11. The tibial fracture is exposed at the base of this distal lower leg wound.