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Systematic review of the reconstructive uses of the extensor digitorum brevis flap

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Abstract

 Background

The extensor digitorum brevis muscle (EDB) has been transferred as a pedicled or free flap for various indications, including those requiring functional muscle transfers. It can be used as a muscle flap or as a compound flap (either a composite or a chimeric flap) including skin, fat and/or nerves. This PRISMA-compliant systematic review reports on the use of EDB flaps to provide an evidence-based report of its indications, complications and outcomes and thereby clarify its utility to reconstructive surgeons.

Methods

PubMed, Embase, and Medline databases were searched for English-language clinical studies (1990 to 2020) of all evidence levels. Cadaveric and studies relating to orthopaedic foot and ankle procedures were excluded. The main outcomes were flap survival, reoperation, revisions and functional outcomes depending on the aim of the reconstruction.

Results

33 papers were eligible (248 flaps). Procedures were classified according to the recipient site of EDB flaps: face (13%), hand (9%) and lower limb (78%). EDB was used as a free flap in 22.6% of cases. EDB flaps were used as a pure muscle flap, or as a compound flap (composite or chimera). In lower limb reconstruction cases, flap blood flow was either anterograde (n = 150) or retrograde (n = 43). EDB flap dimensions ranged 3–4.5 × 6–6.7 cm. There was a 5.2% total and 4% partial flap failure, all limited to anterograde lower limb pedicled applications. Donor site complications included delayed wound healing (7.3%), wound dehiscence (5.4%), reduced ankle mobility (3.9%), hypertrophic scars (3.4%) and paraesthesia over the dorsum of the foot or first webspace (3.4%), amongst others.

Conclusions

EDB flaps have been successfully used in facial, hand and lower limb reconstruction both as soft tissue cover and as a functional transfer. This versatile flap has reasonable low donor site morbidity, reliable anatomy with options for proximal pedicle lengthening and can be used as a pedicled or a free flap.

Level of Evidence: Not ratable.

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Acknowledgements

Mr John Lossaso, deputy librarian, for assistance in locating full texts of potentially eligible studies.

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  1. Department of Plastic Surgery, Salisbury District Hospital, Odstock Road, Salisbury, SP2 8BJ, UK

    Francisco Serra E Moura

  2. Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, UK

    Christopher Lalemi & Nigel Tapia Mabvuure

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Serra E Moura, F., Lalemi, C. & Mabvuure, N.T. Systematic review of the reconstructive uses of the extensor digitorum brevis flap. Eur J Plast Surg 46, 163–180 (2023). https://doi.org/10.1007/s00238-022-01993-8

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