Flexor Digitorum Longus (FDL) or Flexor Hallucis Longus (FHL) Harvesting: Technical Tip and Case Studies

Abstract

Background:

Harvesting of the flexor digitorum longus (FDL) or the flexor hallucis longus (FHL) is a procedure used when tendon transfer is needed. It is commonly used in tibialis posterior reconstruction and Achilles tendon reconstruction. Harvesting of these tendons is sometimes difficult and time-consuming. It is important to obtain sufficient length to make a loop around the navicular bone or anchor it in the calcaneus. We describe a technique in which a loop is passed from proximal identification of the FDL or FHL through the tendon sheath, harvesting it from a minimal plantar approach.

Methods:

After using this technique, we evaluated 10 consecutive patients for neurovascular damage.

Results:

We found no postoperative neurovascular injuries.

Conclusions:

The technique described enables the surgeon to find the FDL/FHL tendon through the medial approach and obtain sufficient length for the procedure by cutting the distal portion of the tendon through an additional plantar incision. Our technical tip for passing the loop facilitates harvest of the tendon easily and safely using the plantar approach.

Level of Evidence:

IV, case series.