Reconstruction of heel defects with a proximally based abductor hallucis muscle flap

The main goals of reconstruction of plantar defects include appropriate soft tissue coverage to facilitate weight bearing, and sufficient blood supply to prevent osteomyelitis. This retrospective study presents the clinical results of 11 patients who received a proximally based abductor hallucis muscle flap for coverage of calcaneal defects. The mean patient age was 43 years (range, 23-69 years). Four patients were women and 7 were men. Seven were non-diabetic patients with neurologic deficits of varying etiology or patients who had pressure ulcers after prolonged hospitalization. Four patients had diabetes with or without neurological deficits, and 6 patients had calcaneal osteomyelitis. In 6 patients, the origin of the muscle was dissected and rotated over the defect. The flap was elevated as an island flap in 5 patients. Postoperatively, partial flap loss was observed in 1 patient, who was then treated successfully with a fasciocutaneous flap. Two patients developed seroma and hematoma at the donor site, which resolved uneventfully after surgical drainage. The 6 patients with calcaneal osteomyelitis showed no recurrence after 1 year of follow-up. The abductor hallucis muscle flap provides enough stability and sufficient blood supply for calcaneal defects up to 3 x 6 cm.