Spider-Plasty: A Modified Z-Plasty Local Flap for Wide Cleft Foot

Cleft foot deformities with significant central ray deficiencies present a unique reconstructive challenge, particularly when there is more than one central ray deficiency or a large cleft space. We are introducing Spider-plasty, a novel modification of the traditional Z-plasty technique, designed specifically for these complex cases. This technique involves strategic rearrangement and redistribution of local soft tissue through multiple Z-shaped incisions, resembling a spider, allowing for optimal tension release, improved tissue coverage, and better cosmetic outcomes. The Spider-plasty method offers enhanced flexibility in managing various degrees of cleft severity by creating multiple skin flaps that can be adjusted individually to fill large cleft gaps, while also promoting better wound healing through preservation of vascular integrity. Spider-plasty is a promising addition to the surgical armamentarium for cleft foot reconstruction, offering a versatile and effective solution for patients with multiple central ray deficiencies or extensive cleft spaces. Level of Evidence: Level V.