Proximally based Abductor hallucis muscle flap in the treatment of osteomyelitis complicated Lisfranc fracture dislocation: A Case Report

Abstract

Anatomic constraints of the foot make it vulnerable to infection when the primary defense, the soft-tissue envelope is compromised due to vicinity of tendons, joints and bone to the skin. Reconstructive efforts in the presence of osteomyelitis compounds the clinical picture. Treatment of midfoot osteomyelitis can have devastating outcomes with loss of biomechanic integrity of the foot, and often loss of part of the foot which at that level results in significant functional deficits. When primary closure is not an option due to potential loss of structural and ultimately biomechanic integrity; soft tissue defects in the presence of exposed tendon, joint or bone with intact vasculotome require expeditious and predictable coverage options. Local muscle flaps belong to the same armamentarium as local random flaps and free flaps considering their unique intricacies. The abductor hallucis muscle flap has been employed for covering soft tissue defects of different etiologies encompassing from the medial hindfoot and ankle to the medial plantar forefoot often with concomitant osteomyelitis of the underlying bone. In this case report, we describe a technique of a proximally based abductor hallucis flap for a patient with traumatic Lisfranc dislocation that developed surgical site infection complicated by osteomyelitis of the tarsometatarsal joint.