Department of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Sydney, NS, Canada.
J Bone Joint Surg Am. 2010 May;92(5):1215-20. doi: 10.2106/JBJS.I.00743.
Soft-tissue coverage and vascularity likely play a vital role in the genesis of wound complications and infections during open Achilles tendon repair. Planning an appropriate surgical approach might decrease the prevalence of these complications.
Five adult cadavers underwent whole-body arterial perfusion with a mixture of lead oxide, gelatin, and water. The skin of the foot and ankle was dissected, and the vascular supply was evaluated with angiography. All angiograms were analyzed with use of statistical software.
We constantly identified three vascular zones: (1) the medial vascular zone, which had the richest blood supply; (2) the lateral vascular zone, in which the density of vascularity was good and much better than that in the posterior zone; and (3) the posterior vascular zone, which showed the poorest blood supply.
The richest vascular zones of the skin covering the Achilles tendon are located toward the medial and lateral aspects of the Achilles tendon. On the basis of the present study, we recommend using a medial or lateral incision in the integument covering the tendon, as the posterior incision will be located in a less vascular zone.
The present study should help the surgeon to plan the surgical approach to the Achilles tendon by designing skin incisions in a more vascular zone.
在开放性跟腱修复过程中，软组织覆盖和血供可能对伤口并发症和感染的发生起着至关重要的作用。规划适当的手术入路可能会降低这些并发症的发生率。
5 具成人尸体接受了由氧化铅、明胶和水组成的混合物的全身动脉灌注。对足部和踝关节的皮肤进行解剖，并通过血管造影评估其血管供应。所有的血管造影都使用统计软件进行分析。
我们始终确定了三个血管区：（1）内侧血管区，其血供最丰富；（2）外侧血管区，其血管密度良好，明显好于后侧区；（3）后侧血管区，其血供最差。
覆盖跟腱的皮肤最丰富的血管区位于跟腱的内侧和外侧。基于本研究，我们建议在跟腱覆盖的皮肤处采用内侧或外侧切口，因为后侧切口将位于血供较差的区域。
本研究应有助于外科医生通过在更具血管区设计皮肤切口来规划跟腱的手术入路。
