RECONSTRUCTION OF SOFT-TISSUE DEFECTS ON THE SOLE OF THE FOOT BY MEANS OF CONTINUOUS SKIN STRETCHING

Reconstruction of the weight-bearing area of the sole of the foot is a major surgical problem, regardless of the aetiology of the soft-tissu e defects. Numerous reconstruction methods have been described for cov erage of plantar defects of the heel with local and free flaps. Skin e xpansion and skin traction have been described by several authors. Acc ording to the Ilizarov technique, a new method has been devised for th e closure of posttraumatic soft-tissue defects in the weight-bearing a rea of the sole by skin stretching with Kirschner wires without the ai d of either local or free flaps. The operative procedure is very simpl e: the sharp ends of Kirschner wires are bent with pliers into hook-sh aped semicircles. These ends are then inserted into the skin of the so le at intervals of 3-4 mm, alternately close to and distant from the w ound edge. The opposite ends of the K-wires are sandwiched between two small AO plates. These plates are pressed together with screws and nu ts; additionally, the ends of the K-wires are bent around the plates t o prevent loosening. A frame is set up around the heel and connected t o the tibial external fixator. The two plates with the K-wires clamped between are mounted on the threaded rods of an Ilizarov external fixa tion system. Then the foot is temporarily fixed to the tibia in neutra l position by a Schanz screw inserted into the first metatarsal. The s oft-tissue defect is treated with moist compresses changed daily. Two days later we start stretching the skin backwards towards the tuber ca lcanei at the rate of 1 mm per day, i.e. 0.25 mm four times daily. The final result is fully sensitive and stable soft-tissue coverage in th e weight-bearing area of the foot. The new area of the sole reconstruc ted by skin stretching exhibits full weight-bearing capability. The co smetic result is very good, and the reconstructed heel looks like the contralateral one. An important advantage of this method is that it do es not need a donor area for local or free-flap skin grafting.