(CS-014) Hybrid Reconstruction of UT Grade 2 and 3 Diabetic Ulcers with External Fixation and Piscine Xenograft

Friday, April 10, 2026

Kimberly Barron, DPM, FACFAS; Collin Pehde, DPM, FASPS

Introduction: Diabetic foot ulcers often require more than local wound care, particularly when correction of mechanical forces and/or advanced offloading is necessary in conjunction with soft tissue reconstruction. This study evaluates a hybrid approach performed at an academic medical center, utilizing external fixation and piscine xenograft in UT Grade 2 and 3 diabetic ulcers.

Methods: A retrospective review was conducted at an academic medical center on patients with UT Grade 2 and 3 diabetic foot ulcers requiring correction of mechanical forces and/or advanced offloading. Circular external fixation was utilized to achieve limb realignment and sustained offloading of the ulcerated region. Following mechanical correction, piscine xenograft was applied to the ulcer bed to facilitate soft tissue regeneration. Patients were followed through the postoperative period until clinical wound closure. Primary outcomes included time to complete epithelialization and occurrence of ulcer recurrence. Secondary outcomes included need for flap coverage, progression to amputation, and fixation-related complications.

Results:

The staged reconstruction protocol combining mechanical offloading and local biologic therapy resulted in progressive granulation and successful wound closure. Superficial pin tract irritation occurred in a limited number of cases and was managed with local care. At follow-up, patients maintained closure of the ulcer site with a plantigrade foot and adequate soft tissue coverage. Patients transitioned to protected weightbearing in accommodative footwear and demonstrated satisfactory functional outcomes without recurrent ulceration at the original site.

Discussion: Hybrid reconstruction using external fixation for correction of mechanical forces and/or advanced offloading alongside piscine xenograft for soft tissue restoration appears to be an effective limb-salvage strategy at an academic medical center for complex UT Grade 2 and 3 diabetic foot ulcers. This combined approach promotes durable wound closure and may reduce reulceration.