External fixators as an adjunct to wound healing

Complex foot and ankle wounds present multiple challenges for the reconstructive surgeon. Soft tissue deficits must be closed to protect underlying structures from infection and to provide a stable environment for healing. Surgical options commonly used include healing by secondary intention, local flap closure, skin grafts, pedicled flaps, and free tissue transfer. Despite a surgeon's best operative efforts, these strategies may fail because of postoperative shear forces created by premature joint motion or pressure (either weight bearing or decubitus). In the properly selected patient population, external fixators serve as an indispensable adjunct to wound healing by providing temporary offloading or immobilization of joints.