PMC5537393_01
First image after injury. 7 x 5 cm defect just anterior of ankle joint .
gr1.jpg
PMC5537393_01_gr1.jpg
fig0005
Tibialis anterior and extensor hallucis longus tendons had defective injury where extensor digitorum longus tendons were intact. (Fig. 1).
The picture of the reconstructed tibialis anterior tendon with interpositional tendon graft which was obtained from extensor hallucis longus.
gr2.jpg
PMC5537393_01_gr2.jpg
fig0010
Defect on the tibialis anterior tendon was reconstructed anatomically with interpositional tendon graft which was obtained from extensor hallucis longus, using "0" no polypropylene (Atramat  Internacional Farmaceutica, Inc.) (Fig. 2).
The picture of elevated 9 x 6 cm ALT flap based on two perforators including fascia.
gr3.jpg
PMC5537393_01_gr3.jpg
fig0015
Anterior tibial artery and accompanying veins were prepared as recipient vessels. 9 x 6 cm ALT flap was elevated based on two perforators including fascia full breadth with the flap dimesion as a tendon gliding surface from ipsilateral thigh (Fig. 3).
The picture of flap after anastomoses.
gr4.jpg
PMC5537393_01_gr4.jpg
fig0020
The anastomoses were performed at proximal wound using end to end fashion with 10/0 polyamide monofilament nonabsorbable sutur(Dafilon Aesculap,Inc.) (Fig. 4).
The picture before and after debulking procedure performed eight years later.
gr5.jpg
PMC5537393_01_gr5.jpg
fig0025
Liposuction was performed at two session for debulking procedure 8 years after the first reconstruction. (Fig. 5).
The picture of extension of the ankle and big toe.
gr6.jpg
PMC5537393_01_gr6.jpg
fig0030
There is no ankle dorsiflexion deficit and extension lack of big toe was disappeared after three years post-operatively, now there is no extension lack of big toe (Fig. 6).