Extensor digitorum brevis free flap: anatomic study and further clinical applications

Area of Science:

• Plastic Surgery
• Anatomy
• Microsurgery

Background:

• The extensor digitorum brevis (EDB) muscle flap is a well-established reconstructive tool, usable as a pedicled or free flap with low donor site morbidity.
• Further anatomical understanding is crucial for optimizing EDB flap design and elevation techniques.

Observation:

• Dissection of 26 cadaver specimens revealed the lateral tarsal artery as the main blood supply to the EDB muscle, with an average diameter of 1.83 mm.
• The dorsalis pedis artery provides a consistent source of arterial supply, measuring 3.25 mm at the lateral tarsal artery takeoff and offering a 6.77 cm usable length.
• Key neurovascular structures, including the anterior tibial artery and deep peroneal nerve, were mapped to ensure safe flap harvesting.

Findings:

• The lateral tarsal artery is the primary vascular pedicle for the EDB flap.
• The dorsalis pedis artery offers a robust and lengthy source vessel for free flap applications.
• Detailed anatomical data provide a basis for refined surgical planning and execution of EDB flap procedures.

Implications:

• This study enhances the anatomical knowledge base for the extensor digitorum brevis flap, enabling more precise surgical applications.
• The findings support the reliable and safe use of the EDB flap in various reconstructive scenarios, including vascularized nerve grafts and bilobed free flaps.
• The presented harvesting techniques, including the "T interposed" method, aim to maximize flap utility while minimizing donor site complications.