[Continuous skin expansion for covering soft tissue defects of the foot sole]

Reconstruction of the weight-bearing area of the sole of the foot is a major surgical problem, regardless of the aetiology of the soft-tissue defects. Numerous reconstruction methods have been described for coverage of plantar defects of the heel with local and free flaps. Skin expansion and skin traction have been described by several authors. According to the Ilizarov technique, a new method has been devised for the closure of posttraumatic soft-tissue defects in the weight-bearing area of the sole by skin stretching with Kirschner wires without the aid of either local or free flaps. The operative procedure is very simple: the sharp ends of Kirschner wires are bent with pliers into hook-shaped semicircles. These ends are then inserted into the skin of the sole at intervals of 3-4 mm, alternately close to and distant from the wound edge. The opposite ends of the K-wires are sandwiched between two small AO plates. These plates are pressed together with screws and nuts; additionally, the ends of the K-wires are bent around the plates to prevent loosening. A frame is set up around the heel and connected to the tibial external fixator. The two plates with the K-wires clamped between are mounted on the threaded rods of an Ilizarov external fixation system. Then the foot is temporarily fixed to the tibia in neutral position by a Schanz screw inserted into the first metatarsal. The soft-tissue defect is treated with moist compresses changed daily.(ABSTRACT TRUNCATED AT 250 WORDS)