Abductor digiti minimi muscle flap in reconstruction
of diabetic foot ulcers: A case series
S. S. Shirol
Received: 12 October 2013 /Accepted: 19 December 2013 / Published online: 14 February 2014
Springer-Verlag Berlin Heidelberg 2014
Background 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.
Methods A retrospective review of all patients with DFUs
with exposed bone and osteomyelitis reconstructed by abduc-
tor digiti minimi muscle flaps and free skin grafting between
January 2010 and December 2011 was conducted.
Results 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 complica-
tions. There was partial loss of skin graft in three cases and
infection and total loss in one other case.
Conclusions Abductor digiti minimi is a safe and reliable flap
that provides a durable cover.
Level of evidence: Level IV, therapeutic study.
Keywords Diabetic foot
Abductor digiti minimi
Diabetic foot ulcer (DFU) reconstruction continues to be a
challenge, considering the varying and complex effects of the
disease on the foot. Local muscle flaps for diabetic foot recon-
struction were pioneered by Ger et al. in late 1960s and contin-
ued to be used for foot and ankle reconstruction till late 1970s
[1–7]. With evolution of microsurgery, free flaps became the
methods of choice. However, there is renewed interest in the
usage of local muscle flaps of the foot, considering their safety,
reliability and operating quickness [8, 9]. Abductor digiti minimi
(ADM) is a small intrinsic muscle of the foot, located on the
lateral aspect of foot, between flexor digitorum brevis medially
and fifth metatarsal and cuboid laterally, that derives type II
blood supply from the branches of medial and lateral plantar
arteries . Here we retrospectively analyze eight cases of
chronic non-healing ulcers managed with ADM muscle flaps.
Materials and methods
All patients with DFUs measuring less than 2.5 cm in diam-
eter, located over the lateral aspect of the foot and heel, with
exposed bone and osteomyelitis, and reconstructed with ADM
muscle flaps and free skin grafting between Jan 2010 and
December 2011 were retrospectively analyzed in this study.
Patients treated conservatively with VAC (vacuum assisted
closure), skin grafts, or other local, regional or free flaps were
S. S. Shirol (*)
Department of Plastic Surgery, K.I.M.S Hubli,
Hubli, Karnataka, India
Department of Plastic Surgery, Hospital Administrator Sampige
Super-specialty Clinic, Hubli, Karnataka, India
Department of Plastic Surgery, KLE University Belgaum,
Eur J Plast Surg (2014) 37:227–232