The conjoint extensor digitorum brevis muscle and dorsalis pedis osteocutaneous island flap.

The privileged donor site of the foot is a well-recognized warehouse for spare parts particularly adaptable for composite tissue replacement of hand defects. Simultaneous microsurgical transfer of many of these parts is frequently performed. The ability to transfer these components on a common vascular leash as distinct yet dependent entities is another variation of this theme that enhances its flexibility. The extensor digitorum brevis muscle island and separate vascularized second metatarsal osteocutaneous flap represent one of many possible technical combinations of conjoined flaps based on the dorsalis pedis source vessel. The muscle portion of this flap provides any necessary soft tissue coverage. Sufficient dorsal foot skin is spared to allow primary closure of the foot, thereby minimizing morbidity in this notoriously difficult donor site.