SLR - August 2010 - Betty Carreira

A Method of External Fixation to Offload and Protect the Foot Following Reconstruction in High-Risk Patients: The SALSAstand.

Clark J., Mills J., Armstrong D. (2009).  A method of external fixation to offload and protect the foot following reconstruction in high-risk patients: the SALSAstand. Eplasty, 9: e21.

Scientific Literature Reviews

Reviews by:
Betty Carreira, DPM PGY-2
Residency Program:  Roxborough Memorial Hospital

Podiatric Relevance:
This article presents a novel technique to completely offload the heel following forefoot amputation or reconstruction in patients at increased risk for more proximal limb amputation, while allowing for triplanar correction and easy access during during changes.

The authors describe the surgical technique for application of half pins, transfixion pins, and rod connector placement for a unique external fixation (SALSAstand) device.  Appropriate foot position in the frontal and sagittal planes is achieved by maneuvering the transfixion pins. The SALSAstand is applied after the foot reconstruction procedure has been completed. Postoperative care consisted of pain management, non-weightbearing, regular dressing changes, meticulous pin site care and antibiotic administration as indicated.

Two unique case studies are presented of high-risk patients (diabetics with one or more co-morbidities) who were placed in SALSAstand following foot reconstruction procedures ([1] a transmetatarsal amputation and [2] a revisional calcaneal debridement with placement of acellular matrix graft). The postoperative course in each case was uneventful resulting in no developments of heel decubitus wounds or equinovarus contracture deformities. The SALSAstand did not require adjustment or removal because it allowed easy access for regularly performed dressing changes.

The adjunctive use of the SALSAstand device appears to effectively elevate, offload, and protect the foot, while also promoting flap healing, maintaining tendon correction, and limiting the tendon retraction and contractures. Hence, the versatile SALSAstand device aids in reducing limb threatening complications in the complicated high risk patient population following foot reconstruction.

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