Lower Extremity Reconstruction—Soft-Tissue Concepts

    What are the boundaries of the femoral triangle?

  Proximally—inguinal ligament.


  Medially—adductor longus.

  Floor—iliacus, psoas, pectineus, and adductor longus.

image    Which muscles of the lower extremity are located in the superficial posterior compartment? What is the innervation and function of each? Superficial posterior compartment?

  Gastrocnemius, innervated by posterior tibial nerve, functions in plantar flexion.

  Plantaris (as for gastrocnemius).

  Soleus (as for gastrocnemius).

image    Deep posterior compartment?

  Flexor hallucis longus/posterior tibial nerve/toe flexion.

  Tibialis posterior/posterior tibial nerve/inversion and plantar flexion of ankle.

  Flexor digitorum longus (as for flexor hallucis longus).

image    Lateral compartment?

  Peroneus brevis/superficial peroneal nerve/ankle eversion.

  Peroneus longus (as for brevis).

image    Anterior compartment?

  Tibialis anterior/deep peroneal nerve/ankle dorsiflexion.

  Extensor digitorum longus/deep peroneal nerve/toe extension.

  Extensor hallucis longus/deep peroneal nerve/toe extension.

  Peroneus tertius/deep peroneal nerve/ankle eversion and weak dorsiflexion.

image    In which compartments do the trifurcated arteries travel in the lower extremity?

Anterior tibial artery—anterior compartment.

Posterior tibial artery—deep posterior compartment.

Peroneal artery—deep posterior compartment.

image    What nerve may accompany the lesser saphenous vein and what does it innervate?

The sural nerve provides sensation to the skin over the posterolateral lower extremity, the lateral heel, and the lateral border of the foot. It is found between the Achilles tendon and lateral malleolus and up to 25 cm can be harvested.

image    The plantar surface of the foot may be divided into four layers. Which muscles may be found in the most superficial layer?

  Flexor digitorum brevis.

  Abductor hallucis.

  Abductor digiti quinti.

image    What nerves provide sensation to the foot and what are their respective dermatomes?

  Posterior tibial nerve—plantar midfoot and heel

  Sural nerve—lateral midfoot

  Saphenous nerve—medial ankle

  Superficial peroneal nerve—dorsal distal foot

  Deep peroneal nerve—first web space

image    Which tendon of the lower extremity is the preferred donor for grafting and which nerve is most at risk during harvest?

Plantaris tendon. It is present in approximately 80% of lower limbs. Dissection begins just posterior to the medial malleolus, placing the posterior tibial nerve at risk.

image    What findings are indicative of compartment syndrome?

  Palpable firmness of compartment, pallor, pain on passive extension is compartment-specific:

  Anterior: pain on passive plantar flexion and foot eversion, toe flexion.

  Lateral: pain on passive dorsiflexion and foot inversion.

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Aug 28, 2016 | Posted by in Reconstructive surgery | Comments Off on Lower Extremity Reconstruction—Soft-Tissue Concepts
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