Distally-based (Reverse) Medial Hemi-flexor Hallucis Brevis Muscle Flap in a Series of High-risk Patients: Retrospective Case Series

Background:The first ray provides an important biomechanical function in ambulation. Loss of this region due to ulceration and pursuant amputation poses significant morbidity to patients. Utilizing the distally based (reverse) medial hemi-flexor hallucis brevis (rmFHB) muscle flap to cover defects of this region may decrease patient morbidity, as it may provide needed bulk and durability for rapid coverage and preservation of the first ray. Methods:In this case series, an uncontrolled, retrospective review of the medical records was performed, identifying patients with diabetes who underwent an rmFHB muscle flap performed by a single surgeon. Outcomes measured included the need for secondary soft-tissue procedures at the index surgery; complications; percentage and time to wound healing, defined as epithelialization of wound site; and short-term survival rate (12 months). Results:Healing was demonstrated at a mean of 12 weeks, and the preservation of the distal first ray was achieved in 94% of those patients (12/13). One patient went on to first ray amputation and two were deceased before healing. All patients ambulated in shoes with custom molded inserts without complication postoperatively. No recurrence of ulceration was encountered at 12 months follow-up. Conclusions:This study demonstrates that the rmFHB muscle flap may serve as an option for distal first ray soft-tissue defects when local flap coverage is needed due to exposed deep or avascular structures not amenable to skin grafting or conservative wound care techniques. No cases of recurrence of ulceration occurred during this study.