1 Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
2 Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Foot Ankle Int. 2019 Feb;40(2):224-230. doi: 10.1177/1071100718802255. Epub 2018 Oct 13.
: The extensile lateral calcaneal approach is a standard method for accessing a joint depression calcaneal fracture. However, the operative wound complication rate is high. Previous studies showed a calcaneal branch of the peroneal artery contributing to the calcaneal flap blood supply. This study focuses on the location of the vertical limb in this approach correlating to the aforementioned artery and flap perfusion.
: Ten pairs of fresh-frozen cadaveric lower extremities were used. Extensile lateral calcaneal approach (ELCA) was carried out on both calcanei, where the vertical limb was placed at the line between the posterior border of lateral malleolus and lateral edge of the Achilles tendon for the right side (standard ELCA; sELCA) and at the lateral edge of the Achilles tendon for the left side (modified ELCA; mELCA). The identified vessel in the vertical limb incision was ligated and cut, and the horizontal limb of the incision was carried out as usual. After completion of flap elevation, 80°C water was injected into the popliteal vessel. In addition, thermal images were taken pre- and postinjection. Dye was injected subsequently, and perfusion was recorded in video format.
: Mean pre- and postinjection skin flap temperature difference was significantly higher in mELCA (5.36°C vs 0.72°C, P = .0002). Dye perfusion patterns were significantly better in mELCA ( P = .0013). The calcaneal branch of peroneal artery was found in the vertical incision in 9 of 10 sELCA, with average distance 22.04 mm anterior to the calcaneal tuberosity and 8.22 mm proximal to superior border of the calcaneus, whereas one was found in mELCA, in which perfusion tests still appeared normal.
: The vertical limb of incision during extensile lateral calcaneal approach should be placed at the lateral edge of the Achilles tendon to avoid injuring the calcaneal branch of peroneal artery, which supplies the lateral calcaneal flap. However, further clinical research might be needed to confirm the results of this study.
: This study demonstrates a likely safest position for the proper incision for exposing the lateral calcaneus.
外展外侧跟骨入路是一种标准的方法，用于治疗关节下跟骨骨折。然而，手术伤口并发症发生率较高。先前的研究表明，腓骨的跟骨分支为跟骨皮瓣提供血液供应。本研究重点关注该入路中垂直支的位置与上述动脉和皮瓣灌注的关系。
使用 10 对新鲜冷冻的下肢尸体标本。对双侧跟骨进行外展外侧跟骨入路（ELCA），右侧垂直支位于外踝后缘与跟腱外侧缘之间的连线（标准 ELCA；sELCA），左侧垂直支位于跟腱外侧（改良 ELCA；mELCA）。结扎和切断垂直支切口内的识别血管，按常规进行水平支切口。皮瓣抬起后，将 80°C 的水注入腘血管。此外，在注射前后拍摄热图像。随后注入染料，并以视频格式记录灌注情况。
mELCA 的平均术前和术后皮瓣温差显著较高（5.36°C 对 0.72°C，P=.0002）。mELCA 的染料灌注模式明显更好（P=.0013）。在 10 例 sELCA 中，9 例在垂直切口处发现腓骨跟骨分支，平均距跟骨结节前缘 22.04mm，距跟骨上缘 8.22mm，而在 mELCA 中发现 1 例，尽管灌注试验仍正常。
外展外侧跟骨入路的垂直支切口应置于跟腱外侧，以避免损伤供应外侧跟骨皮瓣的腓骨跟骨分支。然而，可能需要进一步的临床研究来证实本研究的结果。
本研究表明，对于暴露外侧跟骨的适当切口，这是一个可能最安全的位置。
