FIG. 23-12

FIG. 23-13. The tendons of the extensor digitorum brevis muscle have been separated from the overlying extensor digitorum longus tendons. The four slips are retracted together.

FIG. 23-14. The nutrient pedicle to the muscle enters on the deep surface and crosses the proximal third of the muscle.

FIG. 23-15. To gain more pedicle length, the inferior extensor retinaculum has been divided. The proximal muscle origin has been sharply divided, leaving the island muscle flap tethered by the dorsalis pedis vessels.

FIG. 23-16. The island muscle flap easily reaches the recipient defect on the medial aspect of the distal tibia.

FIG. 23-17. The extensor digitorum brevis muscle has been tunneled to the wound and inset beneath the skin edges.

FIG. 23-18. A Penrose drain is used to drain the donor site wound.

FIG. 23-19. The surface was skin-grafted. The vessel was audible by Doppler probe through the graft for post-operative monitoring. There was no subsequent breakdown, and union of the fracture was complete.

CASE 3

A 28-year-old woman sustained bilateral hand burns with marked flexion contractures and unstable scars over the PIP joints.

FIG. 23-20. The right index and left long PIP joints were fused.

FIG. 23-21. Bilateral extensor digitorum brevis muscles were mobilized to restore dorsal coverage and extensor tendons to the right index and long and left long and ring fingers. Left foot.

FIG. 23-22. Right foot.

FIG. 23-23. The pedicle is dissected proximally, transecting the extensor retinaculum to increase its length.

FIG. 23-24. Recipient area, left hand. Muscle laid out over long and ring fingers; pedicle extends to dorsal radial vessels.

FIG. 23-25. The pedicle has been tunneled for the vascular repair.

FIG. 23-26. Recipient area, right hand. Muscle in place over index and long fingers; pedicle reaches dorsal radial vessels in the proximal wound.

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