A Novel Technique for Closing Difficult Diabetic Cleft Foot Wounds With Skin Grafting and a Ring-Type External Fixation System

Treatment of central metatarsal head plantar forefoot ulceration with or without associated underlying osteomyelitis and gangrene usually require resection of the associated central metatarsal rays. Despite various modifications of central metatarsal ray resection, the resultant cleft foot deformity represents a significant challenge to the foot and ankle surgeon. In this regard, the authors present a novel approach using a ring-type external fixation system that uses the principles of Ilizarov to narrow the forefoot cleft followed by application of a split-thickness skin graft over the remaining soft-tissue defect. When compared with previously reported techniques, the authors approach allows precise narrowing of the forefoot, postoperative weightsharing, decreased time frame of actual external fixation device application, and rapid healing via split-thickness skin graft application about the remaining cleft foot deformity, which has the added benefit of producing additional scarring and contracture over time during the skin graft maturation process.