title: A Previously Discounted Flap Now Reconsidered: MatriDerm and Split-Thickness Skin Grafting for Tendon Cover Following Dorsalis Pedis Fasciocutaneous Flap in Lower Limb Trauma.
abstract: OBJECTIVE
  The dorsalis pedis flap has reliable vascularity; however, its use is limited by reports of donor site morbidity including infection, delayed healing, exposure of tendons, and later contractures. The purpose of this study was to demonstrate its continued role in lower limb trauma when the donor site is reconstructed with MatriDerm to avoid complications.
  
  
  METHODS
  A 65-year-old man presented with a displaced, Gustilo 3b open transverse fracture of his left distal fibula. He had a 2 cm(2) open wound over his lateral malleolus.
  
  
  RESULTS
  Following review of possible local options, a dorsalis pedis fasciocutaneous flap was deemed best for coverage, and the donor site was closed with 1-mm MatriDerm dermal matrix and a 6/1000 inch split-thickness skin graft (STSG) in a single stage. Three months postoperatively, the foot had excellent function and cosmesis, with toes in a neutral position and a full range of movement.
  
  
  CONCLUSIONS
  The dorsalis pedis flap is a valuable reconstructive option for defects of the foot and ankle. Its major limitation donor site morbidity can be overcome by the additional application of a dermal substitute such as MatriDerm under the STSG.
authors.affiliation: Department of Plastic Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Dunne
authors.affiliation: Department of Plastic Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wilks
authors.affiliation: Department of Plastic Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Rawlins
keywords: MatriDerm; dorsalis pedis flap; lower limb trauma; reconstruction; skin