Application of abductor digiti minimi muscle flap and synthetic electrospun fiber matrix after resection of osteomyelitis of fifth metatarsal: A two-patient case report

Diabetic patients often experience lower extremity wounds resulting from foot deformity, poor circulation and neuropathy. Conditions such as gangrene or osteomyelitis often require surgical intervention resulting in large tissue defects. Use of a muscle flap may be considered to fill in the wound defect, cover exposed bones, and bring in well vascularized tissue to the area. Synthetic electrospun fiber matrix (SEFM) offers a unique construct to augment these flap procedures and allows for quicker wound healing. In the present two-patient case report, patients underwent SEFM-augmented abductor digiti minimi muscle flaps to encourage healing of large surgical defects on the lateral foot. Both patients presented with gangrenous and infected wounds requiring surgical resection and debridement of fifth metatarsal to address underlying osteomyelitis and necrotic bone. Subsequently, proximally or distally based abductor digiti minimi muscle flap was performed and the SEFM was then applied over the muscle flap. Both wounds achieved closure at around 14 weeks without complication. Use of the SEFM in conjunction with perforator-based muscle flaps represents a novel approach in treating poorly vascularized surgical wounds in a challenging patient population.