Abductor Digiti Minimi Muscle Flap Research Articles

Lateral Malleolar Defect Coverage Using Abductor Digiti Minimi Muscle Flap.

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. 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. 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. 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.

Abductor digiti minimi muscle flap in reconstruction of diabetic foot ulcers: A case series

Diabetic foot ulcers (DFUs), a leading cause of amputations, affect 15 % of people with diabetes. Wound coverage in these patients is changelling due to concurrent infection, neuropathy and vascular compromise. Though local muscle flaps were described by Ger et al. and popularized by Attinger et al., these small muscle flaps should be more routinary than they are now. A retrospective review of all patients with DFUs with exposed bone and osteomyelitis reconstructed by abductor digiti minimi muscle flaps and free skin grafting between January 2010 and December 2011 was conducted. This study included eight patients. Six patients had ulcers over the heel and two on the lateral aspect of the forefoot. All flaps survived well with no donor site complications. There was partial loss of skin graft in three cases and infection and total loss in one other case. Abductor digiti minimi is a safe and reliable flap that provides a durable cover. Level of evidence: Level IV, therapeutic study.

Die M.-abductor-digiti-minimi-Lappenplastik zur Defektdeckung im Handbereich

Defect coverage of the ulnar aspect of the hand, wrist and hypothenar with an abductor digiti minimi muscle flap and split skin graft. Soft tissue defects of the ulnar aspect of the hand, wrist and hypothenar. Osteomyelitis of the fifth metacarpal bone. Large defects > 3 × 5cm, complex hand trauma, injuries of the ulnar artery or within the area of the pedicle. Marking of the flap's rotational radius, using the pisiform bone as the center point. Ulnar skin incision and exposure and detachment of the distal flap pole, which is located at the level of the metacarpophalangeal (MCP) joint. Dissection of the abductor digiti minimi muscle flap up to the vascular pedicle in the area of the pisiform bone. Transposition and fixation of the flap onto the defect after opening of the tourniquet. Coverage of the muscle flap with a split skin graft. Wound closure of the donor side. Palmar cast splinting in intrinsic-plus position for 10days physiotherapy. Scar care and compression glove for 3months. In total, 9patients showed good results with a reliable defect coverage due to a constant anatomy and easy preparation.

A Reliable Method for Treatment of Nonhealing Ulcers in the Hindfoot and Midfoot Region in Diabetic Patients

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.

Use of a Muscle Flap and a Split-Thickness Skin Graft for a Calcaneal Osteomyelitis after an Open Reduction and Internal Fixation

Reconstruction of bone and soft-tissue defects after an open reduction and internal fixation of a severely comminuted calcaneal fracture presents a challenge to the treating surgeon. We present a case report in which an abductor digiti minimi muscle flap was used to cover a complicated wound with calcaneal osteomyelitis and wound dehisence at the surgical incision. This muscle flap provides an easy, reliable, and quick method to cover open wounds at the lateral aspect of the foot and ankle.

Harvesting the Abductor Digiti Minimi as a Muscle Plug With the Lateral Calcaneal Artery Skin Flap

The abductor digiti minimi muscle flap and the lateral calcaneal artery skin flap were raised as one combined flap and were used to cover plantar heel wounds with chronic osteomyelitis of the calcaneus. The combined flap was used successfully in 4 patients. The muscle component of the flap obliterated the dead space and provided a vascularized muscle over the debrided calcaneus, and the skin component acted as a sensate flap in the plantar heel.

The abductor digiti minimi muscle flap: An adjunct in the treatment of metacarpal osteomyelitis

The abductor digiti minimi muscle has a constant 1 to 1.5 cm neurovascular pedicle that arises from the ulnar artery and nerve within Guyon's canal. We have successfully used the abductor digiti minimi as a pedicle transfer as an adjunct in the treatment of chronic osteomyelitis of the small and ring finger metacarpal shafts.

Coverage of a carpal tunnel wound dehiscence with the abductor digiti minimi muscle flap

A 41-year-old man who was taking 60 mg of prednisone a day for dermatomyositis developed a wound dehiscence following a carpal tunnel release and flexor tenosynovectomy. Coverage of the exposed carpal contents was provided by using the abductor digiti minimi as a local transposition flap.

Abductor Digiti Minimi Muscle Flap After Tumor Resection in the Hand

Extensive resection of aggressive nonmalignant tumors in the hand not only produces large tissue defects but also leaves important vital structures unprotected. The following case of a 25-year-old woman illustrates the successful use of an abductor digiti minimi muscle flap to provide adequate protective coverage.

The abductor digiti minimi muscle flap

The problems of extensive scarring involving the median and ulnar nerves at the wrist are discussed. Possible methods of separating the dermal cicatrix from the nerves are skin flaps or muscle flaps. A case is presented in which an abductor digiti minimi muscle flap was used. The reasons for this choice are discussed and the technique described.