Purpose: As suggested by MacCraw in 1979, the digitorum brevis extensor island flap provides an excellent local cover for small sized tissue losses of the foot and ankle. Despite its advantages, this alternative is not widely used. We report our experience in 11 cases.

Material and methods: Eleven patients underwent reconstruction procedures using the digitorum brevis extensor island flap. There were nine men and two women, mean age 45 years (36–58). The reconstruction was required for post-traumatic infection sequelae of the ankle for four cases, resection of local malignant lesions of the dorsal foot in three, metatasophalangeal involvement of the great toe (septic arthritis and deep electric burn) for two, and finally fistulised chronic osteitis of the base of the fifth metatarus for one patient with insulin-dependent diabetes mellitus. For eight patients, the flap was harvested from the anteior tibial pedicle and for three, the retrograde flow was fed by the pedious artery to treat metatasophalangeal lesions of the great toe and the base of the fifth metatarsus.

Results: Healing was achieved in all cases with definitive cure of the infectious problem. Subjectively, all patients had a good functional and cosmetic outcome when the flap was harvested on a proximal pedicle. For the single patient with a distal pediculated flap, there as a moderate problem with toe flexion due to adherences. None of the patients developed secondary trophicity problems.

Discussion: The digitorum brevis extensor island flap is a reliable reconstruction option to be discussed as an alternative for distant or free flaps. The pedious muscle flap is easy to harvest and is close to the recipient site limiting functional sequelae. Depending on the pivot point, the pedicle is positioned proximally or distally, the rotation arc being sufficient to reach the ankle or the foot. In addition, this is the only simple local flap, particularly for covering metatasophalangeal joints.

Conclusion: This very useful method merits reconsideration in comparison with other technical solutions for the treatment of small-sized skin loss (20 cm2) or for cure of local infectious lesions of the ankle, the foot and the forefoot.