Sagittal Split Tibialis Anterior Muscle Flap

In Brief The potential use of the tibialis anterior muscle as a vascularized flap requires consideration of some function preservation technique because this is not an expendable muscle. A direct longitudinal vertical or partial sagittal split of this muscle will allow coverage of mid-tibial defects without impairing function. This is a valuable alternative for small defects, especially if the muscle is already exposed in the wound. The muscle must be malleable enough to allow stretching over the tibia, because otherwise posteromedial undermining (as used in the medial- hinged anterior turnover version) would be necessary to obtain the desired reach. This as a variation of the latter, if possible, not only is more expedient to implement but also better preserves the microcirculation of the muscle to ensure viability. Complete coverage of three acute middle-third tibial defects was achieved by sagittally splitting the tibialis anterior muscle and stretching the medial portion over the bone. Undermining was not required, and muscle vascularity was uninterrupted.