The SALSA spike: A novel technique using Kirschner wires to anchor tenuous midfoot and forefoot amputation flaps

Extensive tissue resection often mandates unique approaches to complete a functional reconstruction. While there are numerous options for selecting a donor site for a skin or soft tissue flap, available options for securing a local flap following midfoot amputation are quite limited. Adequate flap fixation is essential to maintain its viability, yet this may be challenging to achieve when there is a substantial residual post debridement requiring coverage and only limited remaining viable surrounding soft tissue available for anchoring. Over thinning the flap may compromise vital circulation to it from plantar (or other pertinent) artery perforators. In our experience, the adjunctive use of Kirschner wire(s) to support external soft-tissue fixation in conjunction with traditional methods has been successful in securing such tenuous fasciocutaneous flaps. To our knowledge, few alternative techniques have been described to fasten flaps in instances of compromised surrounding skin and soft tissue integrity in high-risk patients. This technique offers the surgeon a strong, inexpensive, and versatile solution for soft tissue anchoring. It allows for mechanical creep and ultimately stress relaxation at a potential wound closure site. This manuscript reviews several cases, each using this simple, novel approach to fixate an unsecured flap during the closure of an open amputation.