University of Antwerp, Orthopedics, Verbondstraat 62, Antwerpen, 2000, Belgium.
Foot Ankle Int. 2011 May;32(5):S540-4. doi: 10.3113/FAI.2011.0540.
The Scarf valgus inducing osteotomy of the calcaneus is an operative technique to correct varus deformity of the hindfoot. It is versatile with significant corrective power; however, the neurovascular structures are in close proximity on the medial side and thus may be harmed during the osteotomy. Moreover, because this type of osteotomy can cause a great lateral translation, traction of the medial neurovascular structures is possible. We performed an anatomic study to evaluate the medial soft tissues after a lateralizing Scarf-type calcaneal osteotomy.
The osteotomies were carried out on ten fresh-frozen cadaver specimens. We performed the osteotomy and induced valgus. Then we performed a medial dissection to identify the important medial structures: the medial and lateral plantar nerve (MPN , LPN) and the posterior tibial artery (PTA). We noted their relation to the osteotomy and their integrity.
In several cases, one or more of the structures were sectioned. In five cases, all the structures crossed the osteotomy, four of which even a transection of one or both of the plantar nerves occurred. Although the PTA crossed the osteotomy in eight specimens, there was no transection of this structure.
Scarf osteotomy of the calcaneus is a highly corrective osteotomy. However, caution must be exercised when performing as the medial neurovascular structures cross the osteotomy lines and transection can occur.
When performing the osteotomy one should keep in mind that vigorous sawing and large displacement can cause damage to the medial neurovascular structures.
跟骨 Scarf 外展截骨术是一种矫正后足内翻畸形的手术技术。它具有很大的矫正力，且用途广泛；然而，内侧的神经血管结构非常接近，因此在截骨过程中可能会受到损伤。此外，由于这种类型的截骨术可能会导致很大的外侧移位，内侧神经血管结构可能会受到牵引。我们进行了一项解剖学研究，以评估外侧化 Scarf 型跟骨截骨术后的内侧软组织。
对十个新鲜冷冻的尸体标本进行了截骨术。我们进行了截骨术并诱导外翻。然后我们进行了内侧解剖以识别重要的内侧结构：内侧和外侧足底神经（MPN、LPN）和胫后动脉（PTA）。我们记录了它们与截骨术的关系及其完整性。
在几种情况下，一个或多个结构被切断。在五种情况下，所有结构都穿过了截骨线，其中有四个甚至切断了一个或两个足底神经。尽管 PTA 在八个标本中穿过了截骨线，但没有切断这个结构。
跟骨 Scarf 截骨术是一种高度矫正的截骨术。然而，在进行手术时必须小心，因为内侧神经血管结构穿过截骨线，可能会发生切断。
在进行截骨术时，应牢记剧烈锯切和大的移位可能会导致内侧神经血管结构受损。
