A reliable method for treatment of nonhealing ulcers in the hindfoot and midfoot region in diabetic patients: reconstruction with abductor digiti minimi muscle flap.

The foot has a unique anatomic composition and a perfect architecture, which is necessary for mobilization. However, this complex structure is also responsible for healing problems in foot reconstruction. After 25 years of experience in diabetic foot surgery practice, we observed that some hindfoot ulcers are like an iceberg in that they have much more involvement in the plantar fat pad than the skin, and the lateral midfoot region is a common site for ulcer formation. Also the fifth tarsometatarsal joint region is a prominent anatomic structure vulnerable to repetitive trauma and ulcer formation that may easily spread to other parts of the foot. These ulcers should be reconstructed with well-vascularized tissues such as muscle flaps after debridement. Between 2003 and 2010, 17 diabetic patients with foot ulcers, involving bone and joint, were reconstructed with abductor digiti minimi muscle flap. When it is needed, the flap is covered with a small split-thickness skin graft. 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. Diabetic foot ulcers should be evaluated and treated individually depending on their location and affected tissue composition. The most appropriate reconstructive option should be selected for each lesion. The abductor digiti minimi muscle flap is extremely useful for the reconstruction of small- to moderate-sized defects that have exposed bone, joint, or tendons in the hindfoot and lateral plantar midfoot.