Chronic Diabetic Heel Ulcer With Rare Multidrug-Resistant Acinetobacter Baumannii-Calcoaceticus Complex Infection Requiring Free Flap Reconstruction and Unconventional Antibiotics

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Problem Addressed: Chronic diabetic plantar heel ulcers with underlying osteomyelitis represent a complex limb salvage problem, particularly in the setting of multidrug-resistant (MDR) infection and loss of specialized weight-bearing soft tissue. Successful reconstruction requires eradication of infection while restoring durable plantar padding and protective sensibility capable of withstanding repetitive shear and load. Technique: A 65-year-old man with type 2 diabetes mellitus and peripheral neuropathy developed a chronic plantar heel ulcer following immobilization for an Achilles tendon rupture, complicated by calcaneal osteomyelitis and recurrent methicillin-sensitive Staphylococcus aureus bacteremia. The wound persisted despite prolonged offloading, orthotic management, and hyperbaric oxygen therapy. After presentation with sepsis, he underwent definitive limb salvage reconstruction. Following radical debridement and partial calcaneal resection to viable margins, a sensate medial plantar artery pedicled flap was used to restore weight-bearing plantar skin. A chimeric thinned parascapular fasciocutaneous free flap was concurrently utilized to augment soft tissue bulk and obliterate cavitary dead space. Tarsal tunnel release with intraneural neurolysis was performed to optimize protective sensation, and indocyanine green angiography confirmed flap perfusion intraoperatively. Postoperative tissue cultures revealed MSSA and a rare, extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex isolate, demonstrating resistance to all tested antimicrobial agents with only intermediate susceptibility to minocycline. This uncommon resistance profile necessitated coordinated multidisciplinary management with advanced combination antimicrobial therapy. The patient was maintained on strict offloading with intensive flap monitoring. As edema resolved, secondary debulking with local tissue rearrangement was performed to refine contour and optimize pressure distribution. Outcomes: The patient achieved durable soft tissue coverage with preserved flap viability and no vascular compromise. Secondary contouring restored a more anatomic heel profile, improved shoe accommodation, and reduced focal pressure points. This case highlights a defect-driven reconstructive strategy integrating sensate and fasciocutaneous free tissue transfer, with staged refinement, for complex diabetic heel reconstruction in the setting of MDR infection.

Volume

14

Issue

S4

First Page

18

Last Page

19

Comments

Michigan Academy of Plastic Surgeons Annual Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276768.05862.2d

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