The role of intrinsic muscle flaps in the treatment of calcaneal osteomyelitis associated with heel ulceration in high-risk patients: proximally based abductor hallucis and abductor digiti minimi muscle flaps: Case report and a systematic review

Abstract

The purpose of this study is to demonstrate the use of the abductor hallucis and abductor digiti minimi muscle flaps in high-risk patients with diabetes and peripheral vascular disease for limb salvage involving extensive nonhealing ulcerations of the heel with concomitant osteomyelitis. The second objective is to assess the outcomes and safety of these intrinsic muscles in the surgical reconstruction of foot and ankle wounds. The two patients in this study exemplify the use of intrinsic muscle flaps as a last resort for complex foot pathology. A systematic literature review was conducted using several databases and search engines. A total of twenty-six studies met the inclusion criteria and were used for data extraction. One hundred fifty-two patients, with a total of one hundred fifty-three limbs treated, underwent either abductor hallucis or abductor digiti minimi intrinsic muscle flap for coverage of various foot and ankle pathology. Successful wound healing occurred in all patients, attesting to procedural efficacy and reliability. A major complication occurred in one patient (0.6 %), experiencing complete loss of the flap that was successfully managed with a local fasciocutaneous flap. Despite existing evidence, larger comparative studies are needed to investigate the efficacy of abductor hallucis and abductor digiti minimi muscle flaps in foot and ankle reconstruction.