Colgajo Abductor Del Dedo Gordo Del Pie
Colgajo Abductor Del Dedo Gordo Del Pie
Colgajo Abductor Del Dedo Gordo Del Pie
research-article2017
IJLXXX10.1177/1534734617724306The International Journal of Lower Extremity WoundsRodriguez-Collazo et al
Case Report
The International Journal of Lower
Abstract
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.
Keywords
abductor hallucis brevis, muscle flap, limb salvage, osteomyelitis, amputation
Loss of soft tissue coverage distally around the foot poses Major advantages of muscle flaps are reliable soft tissue
threats of amputation of the exposed boney structures. An coverage of bone and tendons and preservation of arteries
amputation of a portion of the foot leads to loss of the bio- of the lower extremity.5,6 There have been reports of satis-
mechanical structural integrity of the foot. This promul- factory results of distally based abductor hallucis muscle
gates an imbalance with its inherent risks of developing flap for medial forefoot defects.7
new ulcers. This in turn potentiates the limb loss cycle. The reverse abductor hallucis muscle flap is ideally suited
Exposure of critical structures such as joints, bone, liga- for small to moderate-sized defects in the vicinity of the first
ments, and tendons necessitates expeditious closure. The metatarsophalangeal joint based on its arc of rotation. It
longer these structures remain open to the environment, the allows for robust vascularized soft tissue coverage. It is sim-
higher the risk is for that patient developing osteomyelitis ple to rise and is transposed easily within the wound.5
and an amputation. Soft tissue reconstruction of the lower In this article, we present our experience with 5 patients
extremity often requires coverage by local or distant flaps. who failed local wound care and healing by secondary inten-
Utilizing vascularized flaps to attain rapid wound closure tion for at least 6 months duration. The patients were treated
diminishes the risk in our patients with already compro- successfully using reverse abductor hallucis muscle flap.
mised health. This not only allows for immediate closure
but also has the ability to perfuse the area with parenteral
antibiotics.
Patients and Methods
Muscle flaps remain often first choice when dealing From September 2015 to May 2017, 5 distally based abduc-
with bone infections associated with osteomyelitis, soft tor hallucis muscle flaps were used for reconstruction of
tissue infections, and large cavities.1 Because common soft tissue and bone defects of the first metatarsal head
local distally based muscle transpositional flaps have dif- region. Of these patients, 2 were females and 3 were males
ficulty reaching the forefoot plantar region, these defects
are normally treated by free tissue transfer.2 However, 1
Presence St Joseph Health Care, Chicago, IL, USA
free flap procedures are relatively complex, time consum- 2
Flagler Hospital, St Augustine, FL, USA
ing, requires microsurgical expertise, and has donor-site 3
Fairview Hospital, Fairview Park, OH, USA
morbidity, which may not be suitable to candidates who Corresponding Author:
are high risk for long operating times and extensive anes- Grace C. Craig, 2880 Plymouth Ave, Rocky River, OH 44116, USA.
thesia risk.3,4 Email: gracecraigdpm@gmail.com
2 The International Journal of Lower Extremity Wounds 00(0)
Table 1. Five Cases of Abductor Hallucis Muscle Transpositional Flap With Age, Sex, Cause of Defect, Defect Site, Defect Size,
Follow-Up, and Complications.