Vascularization of the Lateral Heel in Relation to Extensive Skin Incisions in Osteosynthesis of Calcaneal Fractures
Authors:
V. Rak 1; P. Matonoha 2; M. Otáhal 1; M. Mašek 1
Authors‘ workplace:
Klinika úrazové chirurgie LF MU a FN Brno, přednosta kliniky: doc. MUDr. M. Mašek, CSc.
1; Anatomický ústav Lékařské fakulty MU Brno, přednosta ústavu: prof. RNDr. P. Dubový, CSc.
2
Published in:
Rozhl. Chir., 2007, roč. 86, č. 9, s. 483-488.
Category:
Monothematic special - Original
Overview
The aim of the study was to document soft tissue vascularization of the lateral heel on cadavers and, therefore, to indirectly demonstrate the importance to perform perfectly precise incisions, in order to prevent ischemic complications.
Sections of 8 human lower limb cadavers were performed in cooperation with the Anatomical Institute of the MU Medical Faculty in Brno, according to current common standards for anatomical preparations. In successive steps, cutaneous and subcutanous covers of the lateral ankle, malleolar and heel regions were preparated. Final branches of the individual arteries were followed and the authors aimed to demonstrate their vascular arcade consisting of anastomosis of the lateral calcaneal artery – LCA (a branch of a. peronea) – which is a clinical term for rami calcaneares laterales, ventrolateral tarsal arteries – LTA (a branch of a. dorsalis pedis) and lateral malleolar artery branching off medially – LMA (a branch of a. tibialis ant.). The course of the arteries and their location is related to a reference point – a lateral tip of the lateral ankle.
The investigators found out that all three arteries, as well as the arterial arch, had standard courses. The course of the arch defines the outline of the lateral extensive incision during osteosynthesis in calcaneal fractures, which lies fairly close to the lateral outline of this vascular arcade. Incorrect performance of the incision results, invitably, in serious ischemic complications.
Open reduction and internal fixation of intraarticular calcaneal fractures has become a standard surgical method. Correct indication, good timing and saving open reduction, internal fixation using arthroscopy and early mobilization are the prerequisites to prevent further postoperative complications and to achieve complete healing of the fracture. Considering the demandingness of these fractures treatment and their rare incidence, their management should be centred in specialized traumatological clinics.
Key words:
intra-articular calcaneal fractures – lateral calcaneal flap – lateral extensile incision – blood supply
Sources
1. Andermahr, J., Helling, H. J., Landwehr, P., Fischbach, R., Koebke, J., Rehm, K., E. The Lateral Calcaneal Artery. Surg. Radiol. Anat., 1998, 20, 6, s. 419–423.
2. Andermahr, J., Helling, H. J., Koebke, J., Rehm, K. E. The Vascularization of the os Calcaneum and the Clinical Consequences. Clin. Orthop. Rel. Res., 1999, 363, 7, s. 212–218.
3. Benirschke, S. K., Kramer, P. A. Wound Healing Complications in Closed and Open Calcaneal Fractures. J. Orthop. Trauma, 2004, 18, 1, s. 1–6.
4. Borrelli, J., Lashgari, C. Vascularity of the Lateral Calcaneal Flap: A Cadaveric Injection Study. J. Orthop. Trauma, 1999, 13, 2, s. 73–77.
5. Brauer, C. A., Manns, B. J., Ko, M., Donaldson, C., Buckley, R. An Economic Evaluation of Operative Compared With Nonoperative Management of Displaced Intra-articular Calcaneal Fractures. J. Bone Jt. Surg., 2005, 87-A, 12, s. 2741–2749.
6. Carr, J. B. Surgical Treatment of Intra-articular Calcaeneal Fractures: A Review of Small Incision Approaches. J. Orthop. Trauma, 2005, 19, 2, s. 109–117.
7. Clare, M. P., Lee, W. E., Sanders, R. W. Intermediate to Long Term Results of Treatment Protocol for Calcaneal Fractures Malunions. J. Bone Jt. Surg., 2005, 87-A, 5, s. 963–973.
8. Displaced Intraarticular Calcaneal Fractures. Prognostic Factors for Poor Outcome. Orthop. Trauma Dir., 2004, 6, s. 9–16.
9. Eastwood, D. M. Foot (calcaneus/talus/metatarsus): decision making, AO Principles of Fract. Management. Thieme Stuttgart, N. Y., 2001, s. 587–595.
10. Freeman, B. J. C., Surf, S., Allen, P. E., Nicholson, H. D., Atkins, R. M. The Extended Lateral Approach to the Hindfoot. An Anatomical Basis and Surgical Implications. J. Bone Jt. Surg., 1998, 80, s. 139–142.
11. Herscovici, D., Widmaier, J., Scaduto, J. M., Sanders, R. W., Walling, A. Operative treatment of Calcaneal Fractures in Elderly Patiens. J. Bone Jt. Surg., 2005, 87 A, 6, s. 1260–1264.
12. Huang, P. J., Huang, H-T., Chen, T-B., Chen, J-Ch., Lin, Y-K., Cheng, Y-M., Lin, S-Y. Open Reduction and Internal Fixation of Displaced Intra-Articular Fractures of the Calcaneus. J. Trauma, 2002, 52, 5, s. 946–950.
13. Chao, W., Mizel, M. S. What‘s New In Foot And Ankle Surgery. J. Bone Jt. Surg., 2006, 88-A, 4, s. 909–922.
14. Ishikawa, K., Isshiki, N., Hoshino, K., Mori, C. Distally Based Lateral Calcaneal Flap. Ann. Plast. Surg., 1990, 24, s. 10–16.
15. Keener, B. J., Sizensky, J. A. The Anatomy of the Calcaneus and Surrounding Structures. Foot Ankle Clin. N. Am., 2005, 10, 413–424.
16. Kitaoka, H. B., Alexander, I. J., Adelaar, R. S., Nunley, J. A., Myerson, M. S. Clinical Rating System for the Ankle –Hindfoot, Midfoot, Hallux, and Leaser Toes. Foot Ankle Int., 1994, 15, 7, s. 349–353.
17. Kočiš, J., Stoklas, J., Kalandra, S., Čižmář, I., Pilný, J. Nitrokloubní zlomenin patní kosti. Acta Chir. Ort. Traum. Čech., 2006, 73, s. 164–168.
18. Lim, E. V. A., Leung, J.-P. F. Complications of Intraarticular Calcaneal Fracture Clin. Orthop. Rel. Res., 2001, 391, 10, s. 7–16.
19. Longino, D., Buckley, R. E. Bone Graft in the Operative Treatment of Displaced Intraarticular Calcaneal Fractures: Is It Helpful? J. Orthop. Trauma, 2001, 15, 4, s. 280–286.
20. Melcher, G., Degonda, F., Leutenegger, A., Rüedi, T. Ten-Year Follow-up after Operative Treatment for Intra-articular Fractures of the Calcaneus. J. Trauma, 1995, 38, 5, s. 713–716.
21. Palarčík, J., Buček, P., Vopelka, J. Operativní řešení (vybraných) zlomenin kalkanea. Rozhl. Chir., 1997, 76, 5, s. 231–238.
22. Pompach, M., Carda, M., Vanáč, J., Peřina, M. Zlomeniny patní kosti – život ohrožující zranění. Úraz. Chir., 2006, 14, 1, s. 7–11.
23. Rak, V., Buček, P., Ira, D., Mašek, M. Operační metoda léčby nitrokloubních zlomenin patní kosti. Rozhl. Chir., 2006, 85, 6, s. 311–317.
24. Rammelt, S., Amlang, M., Barthel, S., Zwipp, H. Minimally-Invasive treatment of Calcaneal Fractures. Injury, 2004, 35, Suppl. 2, s. S-B55–S-B63.
25. Rammelt, S., Zwipp, H. Calcaneus Fractures. Trauma, 2006, 8, s. 197–212.
26. Sanders, R. Intra-Articular Fractures of the Calcaneus: Present State of the Art. J. of Orthop. Trauma, 1992, 6, 2, s. 252–265.
27. Sanders, R. Current Concepts Review. Displaced Intra-Articular Fractures of the Calcaneus. J. Bone Jt. Surg., 2000, 82, 2, s. 225–250.
28. Sanders, R., Fortin, P., DiPasquale, T., Walling, A. Operative Treatment in 120 Displaced Intraarticular Calcaneal Fractures. Clin. Orthop. Rel. Res., 1993, 290, 5, s. 87–95.
29. Simpson, R. B. Fractures of the Calcaneus. Curr. Opin. Orthop. 2007, 18, s. 124–127.
30. Stehlík, J., Štulík, J. Zlomeniny patní kosti. 1. vyd. Praha: Galen, 2005. 114 s. ISBN 80-7262-328-1.
31. Thermann, H., Krettek, C., Hüfner, T., Schratt, H.-E., Albrecht, K., Tscherne, H. Management of Calcaneal Fractures in Adults. Clin. Orthop. Rel. Res., 1998, 353, 8, s. 107–124.
32. Vaněček, L., Malkus, T., Dungl, P. Léčba zlomenin patní kosti otevřenou repozicí z mediálního přístupu. Acta Chir. Ort. Traum. Čech., 2003, 70, s. 100–107.
33. Wondrák, E. Zlomeniny kosti patní. Praha, Stát. zdrav. nakl., 1964, 94 s.
34. Zwipp, H., Rammelt, S., Barthel, S. Calcaneal Fractures – Open Reduction and Internal Fixation (ORIF). Injury, 35, Suppl. 2004, 2, s. S-B46–S-B54.
35. Zwipp, H., Rammelt, S., Barthel, S. Kalkaneusfraktur. Unfallchirurg, 2005, 108, 9, s. 737–748.
36. Zwipp, H., Tscherne, H., Wulker, N. Osteosynthese Dislozierter Intraartikulärer Calcaneus Frakturen. Unfallchirurg, 1988, 91, s. 507–515.
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Perspectives in Surgery
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