Early Experience with Force-Modulating Tissue Bridges (FMTB, Brijjit) for Skin Closure in Foot and Ankle Surgery: A Single-Surgeon Case Series.

Background: Wound complications following foot and ankle surgery remain challenging, with rates of 4% to 36% depending on procedure complexity. Mechanical tension contributes to dehiscence through mechanotransduction pathways. The force-modulating tissue bridge (FMTB) reduces tissue-interface pressure from approximately 4000 mm Hg (sutures) to 20 mm Hg. Randomized controlled trial evidence in breast surgery demonstrates 89% relative risk reduction in wound complications; however, data specific to foot and ankle surgery are lacking. Methods: Retrospective case series of consecutive foot and ankle operations closed with FMTBs by a single fellowship-trained surgeon (March-October 2025). Primary outcome was any wound complication within 90 days. Each event was retrospectively classified using a framework consistent with ISO 14155:2020 to distinguish FMTB application-site reactions from other causes. Results: Twenty-nine patients were included (mean age 57.2 years; 66% male; mean body mass index [BMI] 30.9). Most procedures involved the ankle (62%), with complex reconstructions predominating (mean tourniquet time 104 minutes). The 90-day wound complication rate was 41.4% (12/29; 95% CI: 25.5%-59.3%), consistent with published rates for complex foot and ankle procedures when all wound events are captured. Major complications occurred in 3 patients (10.3%); all were attributable to severe patient-level confounding factors (pre-existing osteomyelitis, morbid obesity with heavy smoking history, and chlorhexidine allergy) rather than the FMTB device. After applying this classification framework, FMTB application-site skin reactions occurred in 2 patients (6.9%). Notable among those without complications was 1 patient with BMI 48.5 and only 1 remaining lower limb. Conclusion: This case series describes the feasibility and acceptable tolerance of FMTB closure in a consecutive cohort of foot and ankle procedures spanning the full clinical spectrum. The 90-day wound complication rate (41.4%, 95% CI 25.5%-59.3%) is consistent with published rates for high-complexity foot and ankle surgery when all wound events are captured; device-application-site skin reactions occurred in 6.9% of patients (2/29) and resolved with local wound care. These descriptive data do not establish comparative efficacy. Prospective controlled studies are needed to determine whether FMTB-mediated tension offloading provides incremental wound-healing benefit over conventional closure in this anatomically challenging region. Level of Evidence: Level IV, therapeutic, retrospective case series.