External Fixation for Surgical Offloading of the Diabetic Foot.

The concept of surgical offloading with external fixation is especially relevant when managing diabetic patients with lower extremity wounds refractory to conservative treatment with traditional offloading. This article provides a case report and review of external fixation as a powerful device in accelerating wound healing and providing correction of osseous deformities simultaneously in the diabetic foot.

Soft Tissue and Osseous Substitutes for the Diabetic Foot.

Several soft tissue and osseous substitutes have become widely available for consideration in diabetic foot and ankle reconstruction. Although autogenous skin and bone grafts remain the gold standard, the diabetic foot often presents with challenging clinical scenarios in which these options are limited or contraindicated. Selection of the appropriate substitute depends on the patient's medical status, type and extent of soft tissue and bone loss, and expected function of the given site.

The "1-4-4-2" Model for the Diabetic Foot Team.

The cause of diabetic foot complications is often multifactorial; therefore, expertise from multiple surgical and medical specialties is warranted for improved clinical outcomes. Teamwork should be carefully coordinated with strategic planning and treatment should be adaptable to the given clinical scenario. This article describes the formation and interplay of an effective multidisciplinary team for the treatment of the diabetic foot analogous to that seen in elite team sports.

Modification of the abductor digiti minimi muscle flap for soft tissue coverage of the diabetic foot.

The local intrinsic abductor digiti minimi muscle flap is ideal for lateral, plantar lateral traumatic or diabetic foot wounds following adequate surgical debridement to eradicate any soft tissue and/or osseous infection. Although the indications and surgical technique have been well-described in the literature, the authors present a unique modification of tunnelling the harvested muscle flap directly from the donor site to the plantar recipient foot wound by maintaining the intact overlying skin island at the surface of the fifth metatarsal base. This modification allows preservation of the patient's skin integrity in this area, thereby minimising potential morbidity at the major pedicle site.