(DLS-016) Double local muscle flaps for coverage of soft tissue defect in the foot

Griffin Van, DPM – Resident Physician, MedStar Georgetown University Hospital; Aria Mansoori, DPM – Resident Physician, MedStar Georgetown University Hospital; Jayson Atves, DPM – Attending Physician, MedStar Georgetown University Hospital; Christopher Attinger, MD – Attending Physician, MedStar Georgetown University Hospital

Introduction: Lateral midfoot wounds are common in dysvascular/neuropathic patients. The purpose of this study is to present a technique for double local foot muscle flaps (abductor digiti minimi and flexor digitorum brevis) for coverage of soft tissue defects at the lateral midfoot.

Methods: 87M with vascular disease and right below knee amputation presented with left foot wound at level of the 5th metatarsal base. Vascular surgery performed an angiogram showing patent posterior tibial and peroneal arteries. We opted for flexor digitorum brevis and abductor digiti minimi muscles to cover the lateral foot wound, as they were in close proximity and are both supplied by branches of the posterior tibial artery.


No tourniquet used. Our technique used an incision distal to the wound along the glabrous junction of the 5th metatarsal to expose the abductor digiti minimi (ADM) and flexor digitorum brevis (FDB) muscles. We isolated FDB, dopplering the dominant pedicle. FDB was reflected at the most distal segment to allow enough length to be rotated 180 degrees, while continuing to have dopplerable signal. This covered the superior portion of the defect. The ADM muscle pedicle was then dopplered out and the muscle was reflected and lateralized, covering the remaining inferior aspect. The glabrous junction was primarily closed.

Results: At 1 year, the wound remained healed. Limb salvage was successful. Patient weight-bears on left foot and ambulates with cane and right prosthetic leg.

Discussion: Traditional lower limb reconstruction includes muscle, microvascular, and perforator flaps. To reduce donor-site morbidity, local foot flaps have become good options for limb salvage.