Lateral Malleolar Defect Coverage Using Abductor Digiti Minimi Muscle Flap

Abstract

Introduction The lateral malleolar region is a prominent anatomic structure vulnerable to repetitive trauma and ulcer formation. The abductor digiti minimi (ADM) muscle flap offers a promising treatment option for the reconstruction of small- to moderate-sized defects that have exposed bone, joint, or tendons in the lateral malleolar area. Methods Between 2013 and 2016, 8 patients with foot ulcers were reconstructed with ADM muscle flap. The muscle component of the flap obliterated the dead space and provided a vascularized muscle over the debrided ankle joint. When it is needed, the flap is covered with a small split-thickness skin graft. Results In all cases, complete healing was achieved. The muscle flap functioned well as a versatile and shock absorbent coverage without recurrence of the ulcer during a mean follow-up period of around 2 years. Conclusions Coverage of a soft tissue defect at the lateral side of the ankle remains a challenge for surgeons because of the limited possibilities for local transposition. Free flaps have frequently been associated with postoperative complications and higher costs. Also, not all patients are suitable candidates for free tissue transfer because of existing comorbidities. Coverage with a split-thickness skin graft will not be possible for wounds with exposed bone or neurovascular structures or in wounds involving the weight bearing surface of the foot. Using ADM muscle offers no donor site morbidity, good soft tissue coverage, and an effective healing process. Also, no limb movement affection and normal daily life are acquired.

Personalized approach for complex bilateral calcaneal osteomyelitis and defect reconstruction with bilateral abductor digiti minimi flaps

“…The treatment of combined bone and soft tissue defects is extremely challenging. Pedicled or free tissue transfer may be required to avoid calcanectomy which has a profound impact on global foot function [ 9 , 10 ]. Due to the irregular calcaneal anatomic shape, complex biomechanics of adjacent joints, and delicate soft tissue cover, in order to create an individual treatment concept, interdisciplinary management by orthopedic and plastic surgeons is indispensable in these cases [ 10 ].…”

“…Abductor digiti minimi flaps is a well-established procedure in plastic and reconstructive surgery with a minimal functional defect and morbidity at the donor site [ 9 ]. Nevertheless, it represents a good technique to cover lateral heel defects resulting from debridement after chronic osteomyelitis of the calcaneus with fistula formation.…”

“…Another treatment options for salvage at the critical situation of bilateral and symmetrical appearance but also for the filling large of bone defects following calcaneal osteomyelitis and debridement. These include calcium phosphate-based bone cements or hydroxyapatite-based ceramics with and without antibiotics, autologous and allogeneic bone grafting, muscle flaps, and composite vascularized bone and soft tissue transfer for combined lesions [ 9 ].…”

“…Development of deep infection with osteomyelitis of the calcaneus represents a worst-case scenario and may lead to partial or total calcanectomy with serious permanent functional impairment of the affected patients [ 9 , 10 ]. Therefore to avoid this kind of situations, a reconstructive concept should be chosen, one of them being the adbductor digiti minimi flap.…”