(1)
Yotsuya Medical Cube, Chiyoda-ku, Tokyo, Japan
Basic Principles
The most common cause for covering the dorsum of the toes is the great toe. In the case that tendon and bone are exposed, either a muscle flap or skin flap is required, however the easiest method with a stable blood supply is a reverse muscle flap using the extensor digitorum brevis muscle flap.
Selectable Flaps and Surgical Procedures
Reverse flow extensor digitorum brevis muscle flapArtificial dermisand skin graftSkin graft with negative pressure wound therapyThe difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.
21.1 Reverse Flow Extensor Digitorum Brevis Muscle Flap (Level of Difficulty: 3)
Information
Vascular pedicle Lateral tarsal blood vessels (branches from the dorsal artery beneath the extensor retinaculum)
Size 4.5 × 6 cm
Advantage Blood flow is stable, it is not bulky and there is no loss of function due to harvesting. Suitable for covering exposed tendons or bone of the dorsum. The vascular pedicle is beneath the extensor retinaculum of the ankle, and some distance from the area requiring covering, so in many cases is not damaged.
Disadvantage Size of muscle flap is small. Requires skin graft
Caution Incision is made slightly medial along the dorsal artery. The connection branch between the dorsal artery and plantar artery must be left intact
21.1.1 Operation Procedures
Fig. 21.1
Procedure 1: Case of necrosis of great toe due to amputation
