The ankle extensor-tendon-sheath flap--a versatile fascial flap for coverage of the tibia and pretibial area: a preliminary report.

In April 2003, the author presented the use of the common peroneal tendon sheath as a vascularised fascial flap serving to cover exposed Achilles tendons in four patients. This flap was referred to as the peroneal tendofascial flap. The gross anatomy and blood supply of the tendon sheaths in the extensor compartment of the leg were studied in 15 below-knee amputation specimens. The tendon sheath was found to possess two distinct layers: an inner one that harbours the synovial sheath and belongs to each tendon separately, and a common outer layer ensheathing all the tendons within the extensor compartment. The outer layer was mainly nourished via five septal perforators anastomosing with each other. These anastomoses result in forming longitudinal sizeable vessels along the septum. The dissection of this newly described layer resulted in a proximally based axial fascial flap in four cases. The flaps with overlying split-thickness skin grafts (STSGs) were used successfully to cover soft-tissue defects overlying the tibia and pretibial area. Follow-up for at least 6 months proved the durability and sufficient coverage of the ankle extensor-tendon-sheath flap.