Modification of the abductor digiti minimi muscle flap for soft tissue coverage of the diabetic foot

2020 ◽  
Vol 29 (Sup7) ◽  
pp. S32-S36
Author(s):  
Crystal L Ramanujam ◽  
Alan C Suto ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Diabetic Foot ◽  
Donor Site ◽  
Muscle Flap ◽  
Surgical Reconstruction ◽  
Soft Tissue Coverage ◽  
Skin Island ◽  
Abductor Digiti Minimi ◽  
Abductor Digiti Minimi Muscle

The local intrinsic abductor digiti minimi muscle flap is ideal for lateral, plantar lateral traumatic or diabetic foot wounds following adequate surgical debridement to eradicate any soft tissue and/or osseous infection. Although the indications and surgical technique have been well-described in the literature, the authors present a unique modification of tunnelling the harvested muscle flap directly from the donor site to the plantar recipient foot wound by maintaining the intact overlying skin island at the surface of the fifth metatarsal base. This modification allows preservation of the patient's skin integrity in this area, thereby minimising potential morbidity at the major pedicle site. After the harvested muscle is tunnelled through the intact skin island, an adjacent local random flap mobilisation, autogenous or allogeneic skin graft can then be used for coverage over the muscle inset if primary wound closure is not feasible. Simultaneous soft tissue or osseous surgical procedures and/or surgical offloading with external fixation at the time of index surgery may be necessary to achieve optimal outcomes. The authors present a modified surgical technique for the abductor digiti minimi muscle flap that can be performed in the surgical reconstruction of a soft tissue wound in patients with diabetic Charcot neuroarthropathy.

Abductor Hallucis Muscle Flap and Staged Medial Column Arthrodesis for the Chronic Ulcerated Charcot Foot With Concomitant Osteomyelitis

2010 ◽  
Vol 3 (5) ◽  
pp. 269-273 ◽  
Author(s):  
Claire M. Capobianco ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Wound Closure ◽  
Wound Care ◽  
Weight Bearing ◽  
Deformity Correction ◽  
Muscle Flap ◽  
Surgical Reconstruction ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Abductor Hallucis

Midfoot ulceration is a common sequela of the diabetic Charcot rocker-bottom deformity. Because redundant soft tissue from a non— weight-bearing area is often scarce in this area of the foot, soft-tissue coverage may be challenging. Wound closure may be difficult to achieve with local wound care and off-loading techniques if the predisposing deformity that caused the ulceration is not addressed. In the same setting, surgical reconstruction is often feared when open wounds are present, given the potential for infection. Approaching these wounds with a rational stepwise and staged approach is prudent to eradicate the underlying infection and also to achieve durable wound closure and long-term deformity correction. The authors present the use of a local muscle flap and circular external fixation for closure of a recalcitrant Charcot plantar-medial midfoot ulceration and also discuss different adjunctive modalities to facilitate soft-tissue reconstruction in the diabetic foot.

Achilles Tenorrhaphy in Five Dogs: A Modified Surgical Technique and Evaluation of a Cranial Half Cast

1998 ◽  
Vol 11 (04) ◽  
pp. 205-210 ◽  
Author(s):  
H. Burbidge ◽  
E. Firth ◽  
S. Fox ◽  
S. Guerin
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Surgical Procedure ◽  
Normal Function ◽  
Surgical Reconstruction ◽  
Bone Apposition ◽  
Cast Material ◽  
Bilateral Lesions ◽  
Bone Tunnels

SummaryAchilles mechanism rupture in four of five dogs was treated with tenorrhaphy using a modified surgical technique designed to optimise accurate apposition of tendon to bone. Two bone tunnels were drilled in the calcaneal tuber from a plantomedial - dorsolateral, and plantolateral – dorsomedial direction respectively. The distal ends of the tendons were sutured to the calcaneal tuber using a Krachow suture pattern. The remaining dog had a mid-tendon Achilles mechanism rupture. A resinous half cast was placed on the cranial aspect of the tarsocrural joint of all five dogs, for a minimum of six weeks, in order to provide limited post operative support. Du e to insufficient cast material two of the support splints failed and one of these cases also required a second surgical procedure. A varying amount of soft tissue irritation was noted in each case. All of the five Achilles mechanisms healed, and all of the dogs returned to normal function.Five dogs with surgical reconstruction of the Achilles mechanism were stabilised postoperatively with a resinous half cast placed on the cranial aspect of the tarsocrural joint for a minimum of six weeks. Two of these casts failed at the tarsocrural joint when six folds of casting material were used; all subsequent cases had eight folds applied. Variable soft tissue irration was observed under the cast in each case. A modified surgical technique using a Krachow suture pattern allowed good tendon-bone apposition. All five Achilles mechanisms healed, and all dogs returned to normal function. Bilateral lesions were identified in 3 of the 4 dogs examined.

Versatility of the Posterior Interosseous Artery Flap: Emphasis on Powering Up the Toe Transfer

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
GiJun Lee ◽  
BumSik Kim ◽  
Neunghan Jeon ◽  
JungSoo Yoon ◽  
Ki Yong Hong ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Upper Extremity ◽  
Reverse Flow ◽  
Donor Site ◽  
Congenital Defects ◽  
Soft Tissue Coverage ◽  
Posterior Interosseous Artery ◽  
Arterial Inflow ◽  
Pedicle Length ◽  
Interosseous Artery

Background: Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Materials and Methods: Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. Results: This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. Conclusion: The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

Reverse Distally Based Abductor Hallucis Muscle Flap for Soft Tissue Coverage of the First Metatarsophalangeal Joint Wounds

2017 ◽  
Vol 16 (3) ◽  
pp. 208-211 ◽  
Author(s):  
Edgardo R. Rodriguez-Collazo ◽  
Ryan J. Pereira ◽  
Grace C. Craig
Keyword(s):  
Soft Tissue ◽  
Structural Integrity ◽  
Wound Care ◽  
Muscle Flap ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Coverage ◽  
Abductor Hallucis ◽  
First Metatarsophalangeal Joint ◽  
Secondary Intention ◽  
Abductor Hallucis Muscle

Loss of soft tissue coverage distally around the foot poses threats of amputation of the exposed boney structures. An amputation of a portion of the foot leads to loss of the biomechanical structural integrity of the foot. This promulgates an imbalance with its inherent risks of developing new ulcers. This in turn potentiates the limb loss cycle. The reverse abductor hallucis muscle flap is ideally suited for small to moderate-sized defects in the vicinity of the first metatarsophalangeal joint based on its arc of rotation. In this article, we present cases of 5 patients who failed local wound care and healing by secondary intention for at least 6 months duration. The patients were treated successfully using reverse abductor hallucis muscle flap.

The Abductor Digiti Minimi Muscle Flap

1983 ◽  
Vol 72 (6) ◽  
pp. 859-863 ◽  
Author(s):  
Neal R. Reisman ◽  
A. Lee Dellon
Keyword(s):  
Muscle Flap ◽  
Abductor Digiti Minimi ◽  
Abductor Digiti Minimi Muscle

Soft Tissue Reconstruction Pyramid in the Diabetic Foot

2010 ◽  
Vol 3 (5) ◽  
pp. 241-248 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Weight Bearing ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Best Interest ◽  
Foot Complications ◽  
Uncontrolled Diabetes ◽  
Wound Healing Response ◽  
Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

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