The transverse dorsal approach to the Lisfranc joint.

While multiple longitudinal skin incisions can be utilized to visualize the joints of the midfoot, we feel that exposure can be difficult. Dorsal transverse and T incisions were undertaken to expose the tarsometatarsal joints (TMTJs) in 12 patients. Five of the 12 had some form of immunosuppression, including diabetes, methotrexate therapy and antirejection transplant therapy. One patient who had a lengthening of the midfoot with a structural autograft suffered a small area of skin necrosis that healed by secondary intention. The remainder of patient's wounds healed without complication. Three to six dorsal access intervals are created between the neurovascular and musculotendinous structures that overlie the TMTJs. The transverse incision can be extended into a medially based T incision to apply a medial plate as required. Transverse incisions are not recommended for patients who require lengthening of the midfoot.