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Introduction. Pretibial lacerations resulting from trauma may evolve into chronic wounds with worsening infections without treatment. There is a limited amount of literature on the presentation and treatment of recalcitrant pretibial ulcerations. Objective. This study aims to provide a review of surgical treatment methodology that successfully managed recalcitrant pretibial ulcerations. Materials and Methods. The authors conducted a retrospective case review of patients with pretibial ulcerations. All wounds underwent aggressive debridement in the operative setting. Next, the wounds were fenestrated with a needle before placing one application of an antimicrobial acellular dermal tissue matrix derived from fetal bovine dermis, which was tightly adhered onto the wound bed. All wounds received a uniform multilayer compression dressing. Results. Three patients with pretibial ulcerations were included in this study. Each wound was a result of mechanical trauma and deteriorated into a refractory ulceration despite initial conservative treatment for more than 6 months. All ulcers exhibited local infection of cellulitis, hematoma, and a collection of purulent fluid. None of the wounds had any signs of radiographic osteomyelitis. The application of the allograft following debridement and fenestration led to wound volume reduction by 75%, 66.7%, and 50% in 3 patients in 28 days. All wounds healed successfully within 4 months. Conclusions. The combination of a fenestration method and an antimicrobial fetal bovine dermal matrix successfully healed recalcitrant pretibial ulcerations in high-risk patients.

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Atramatic, painful herniation of the abductor hallucis muscle is rare. During the period of writing this case study, we found less than ten published articles on abductor hallucis muscle anatomy and only three case reports on the abnormalities within the abductor hallucis muscle. Familiarity with the condition is needed for early diagnosis, surgical intervention, and prevention of recurrence. It is also important to have an experienced musculoskeletal radiologist to identify this unique pathology. This is a unique case study of a young active female who presented with an abductor hallucis muscle herniation, tarsal tunnel syndrome, and ligamentous laxity. She suffered from foot pain and was misdiagnosed for multiple years. She began living with normal foot pain during her exercise activities. Her symptoms began to worsen with numbness and tingling. After failing modification of shoe gear, physical therapy, resting, and offloading, she was further worked up with imaging. This MRI was evaluated by a musculoskeletal radiologist. It was discovered that she has a large muscle belly, with a retinaculum injury, and impingement along the tarsal tunnel. She was successfully treated with a surgical repair of the herniation, application of synthetic dynamic matrix graft, and decompression of the tarsal tunnel at the porta pedis. She had a complete resolution of symptoms in 6 weeks and she was followed up for 3 years with no recurrence. The purpose of this case report is to add to the body of literature on treatment options for muscle herniation in foot and ankle surgery.