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 extensor digitorum muscle is a small, discrete muscle with a consistent vascular pedicle that allows its transplantation by microvascular anastomoses, as well as its rotation as an island muscle flap. This very thin muscle measures 4.5 cm x 6.0 cm and provides an ideal reconstructive method for small wounds that require soft tissue coverage but do not necessitate the bulk of larger tissue flaps. As a free tissue transplant, the extensor digitorum brevis muscle can be placed in any location on the body with acceptable recipient vessels. As an island muscle flap, it can be rotated over the distal third of the tibia anteriorly and over either of the malleoli. Another advantage is that the donor scar is hidden by normal clothing.

The foot donor site for the extensor digitorum brevis muscle allows two surgical teams to work simultaneously, harvesting the muscle and preparing the recipient site in a free tissue transfer. The location on the foot also allows local flap coverage using the extensor digitorum brevis as an island muscle flap, either proximally or distally based and rotated medially or laterally. The foot dissection must be performed with care because delay in healing in the donor area is common if skin flaps are poorly planned or not protected intraoperatively and postoperatively.


The extensor digitorum brevis muscle has been valuable in providing soft tissue coverage to traumatic defects of the hand, where the thin, well-vascularized coverage contributes to the overall result by avoiding bulkiness, allowing early postoperative hand therapy, and increasing the range of motion. It has been used to resurface unstable coverage in preparation for secondary reconstruction. It has also been used to provide immediate coverage for exposed hand structures in acute injuries.1 The skin-grafted surface is pliable, supple, and durable. The extensor digitorum brevis has also been used to provide opposition in the hand as a functional muscle transplant to the thumb, and to restore hypothenar bulk and function.2

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