Pedicled extensor digitorum brevis flap for the distal third lower limb reconstruction: A review of the literature

Introduction: Reconstruction of the distal lower limb is often complex due to limited local tissues. The pedicled extensor digitorum brevis (EDB) flap is a reliable, loco-regional option for small- to medium-sized ankle and foot defects. This review summarizes literature on pedicled EDB flaps, focusing on indications, outcomes, and donor-site morbidity. Materials and methods: A search of PubMed, Embase, and Scopus (1987-2024) using predefined terms identified studies on pedicled EDB flaps for lower limb reconstruction. Exclusions included anatomical studies, case reports, and free or multiple flaps. Out of 88 records, 26 met criteria, covering 296 patients. Results: Trauma was the leading indication for reconstruction (31.4%), followed by postsurgical dehiscence, infections, and chronic ulcers. Most flaps were pure muscle with an average size of 14.55 cm², covering defects of about 11.89 cm². Complications included total necrosis (4.4%) and partial necrosis (3.7%), all in antegrade flaps. Donor-site issues were limited, mainly delayed healing (5.1%) and wound dehiscence (5.1%), rarely causing major problems. Discussion: The pedicled EDB flap offers predictable anatomy, easy harvest, and minimal functional issues, ideal for small- to medium-sized defects when microsurgery isn't available. However, necrosis risk and trauma links emphasize the need for careful patient selection and vascular assessment. Conclusion: The pedicled EDB flap is a reliable option for distal lower-limb reconstruction, showing good results with manageable complications. More studies are needed to define its long-term role.