The Abductor Digiti Minimi Myocutaneous Island Flap: A Simple Solution for Small Lateral Foot Defects

The reconstruction of soft-tissue defects of the foot represents a complex surgical challenge, often compounded by unfavorable local conditions, such as active infection, exposure of orthopedic fixation material, and abundant fibrosis of the surrounding tissues, as well as vascular, metabolic, and neuropathic comorbidities. The abductor digiti minimi (ADM) muscle flap is a reliable local option for coverage of lateral foot defects, providing well-vascularized tissue with minimal donor-site morbidity. This study presents a technical variation of the ADM flap that incorporates a vascularized skin island overlying the muscle. The anatomical basis, surgical technique, and two illustrative clinical cases are described. In both reported cases, reconstruction achieved stable coverage and complete healing without major complications, even in patients with multiple comorbidities and exposed internal fixation material. Inclusion of a skin island enabled immediate coverage, avoiding the need for secondary grafting and resulting in favorable aesthetic and functional integration. This modification of the ADM flap represents a simple, safe, and reproducible technique that expands local reconstructive options for small lateral foot defects. Further studies are needed to confirm its role within the reconstructive algorithm for the foot.