Examination of Safe Zone to Avoid Injury of the Lateral Plantar Artery During Calcaneal Osteotomy: A Fresh Cadaveric Study

2020 ◽  
pp. 193864002096508
Author(s):  
Ichiro Tonogai ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
External Iliac Artery ◽  
Plantar Fascia ◽  
Safe Zone ◽  
Cadaveric Study ◽  
Medial Side ◽  
Calcaneal Osteotomy ◽  
Plantar Artery ◽  
Perpendicular Distance ◽  
Hindfoot Deformities ◽  
Enhanced Computed Tomography

Background: Calcaneal osteotomy are used to treat various pathologies in the correction of hindfoot deformities. But lateral plantar artery (LPA) pseudoaneurysms have been reported following calcaneal osteotomy, and LPA pseudoaneurysms may be at risk for rupture. Although the vascular structures in close proximity to calcaneal osteotomies have variable courses and branching patterns, there is little information on safe zone for LPA during calcaneal osteotomy. The aims of this study were to identify the safety zone to avoid the LPA injury during calcaneal osteotomy. Methods: Enhanced computed tomography scans of 25 fresh cadaveric feet (male, n = 13; female, n = 12; mean age 79.0 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery. Line A is the landmark line and extends from the posterosuperior aspect of the calcaneal tuberosity to the plantar fascia origin, and the perpendicular distance between the LPA and line A at its closest point was measured on sagittal images. Results: The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 cases (8.0 %), the perpendicular distance between the LPA and line A at its closest point was very close, approximately 9 mm. In 18 of 25 feet (72.0%), the point where perpendicular distance from the line A to LPA is the closest was the bifurcation of one of the medial calcaneal branches from LPA, and in 7 feet in 25 feet (28.0%) feet the point where perpendicular distance from the line A to LPA is the closest was the trifurcation of LPA, medial plantar artery, and one of the medial calcaneal branches. Conclusions: Calcaneal osteotomy approximately more than 9 mm from the line A could injure the LPA in overpenetration into the medial aspect of tcalcaneal osteotomy. Completion of the osteotomy on the medial side should be performed with caution to avoid iatrogenic injury of the LPA. Levels of Evidence:: Level IV, Cadaveric study

scholarly journals Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

2020 ◽  
Author(s):  
Ichiro Tonogai ◽  
Koichi Sairyo ◽  
Yoshihiro Tsuruo Tsuruo
Keyword(s):  
External Iliac Artery ◽  
Plantar Fascia ◽  
Safe Zone ◽  
Cadaveric Study ◽  
Medial Side ◽  
Calcaneal Osteotomy ◽  
Plantar Artery ◽  
Perpendicular Distance ◽  
Risk Of Rupture ◽  
Enhanced Computed Tomography

Abstract Background Calcaneal osteotomy is used to correct hindfoot deformity. Pseudoaneurysms of the lateral plantar artery (LPA) have been reported following calcaneal osteotomy and are at risk of rupture. The vascular structures in close proximity to the calcaneal osteotomy have variable courses and branching patterns. However, there is little information on the “safe zone” during calcaneal osteotomy. This study aimed to identify the safe zone that avoids LPA injury during calcaneal osteotomy.Methods Enhanced computed tomography scans of 25 fresh cadaveric feet (13 male and 12 female specimens; mean age 79.0 years at time of death) were assessed. The specimens were injected with barium via the external iliac artery. A landmark line (line A) connecting the posterosuperior aspect of the calcaneal tuberosity and the origin of the plantar fascia was drawn and the shortest perpendicular distance between the LPA and line A was measured on sagittal images.Results The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 feet (8.0%), the perpendicular distance between the LPA and line A at its closest point was very short (approximately 9 mm). In 18 of the 25 feet (72.0%), the point where the perpendicular distance from line A to the LPA was closest was the bifurcation of one of the medial calcaneal branches of the LPA, and in 7 feet (28.0%) the shortest perpendicular distance from line A to the LPA was the trifurcation of the LPA, medial plantar artery, and one of the medial calcaneal branches.Conclusion Calcaneal osteotomy performed more than 9 mm from line A could damage the LPA by overpenetration on the medial side. Calcaneal osteotomy on the medial side should be performed with caution to avoid iatrogenic injury to the LPA.Level of Evidence: IV, cadaveric study

Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction?

2018 ◽  
Vol 12 (1) ◽  
pp. 34-38
Author(s):  
Bradley Wills ◽  
Sung Ro Lee ◽  
Parke William Hudson ◽  
Bahman SahraNavard ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Anatomical Variation ◽  
Retrospective Chart Review ◽  
Plantar Fascia ◽  
Neurological Complications ◽  
Safe Zone ◽  
Reference Line ◽  
Calcaneal Osteotomy ◽  
Significant Difference ◽  
Osteotomy Line

Background. Calcaneal osteotomy is a commonly used surgical option for the correction of hindfoot malalignment. A previous cadaveric study described a neurological “safe zone” for calcaneal osteotomy. We performed a retrospective chart review to evaluate the presence of neurological injuries following calcaneal osteotomies and the location of the osteotomy in relation to the reported safe zone. Methods. In this retrospective study, we reviewed charts of patients who underwent calcaneal osteotomy at our institution from 2011 to 2015. All immediate postoperative radiographs were examined and the shortest distance between the calcaneal osteotomy line and a reference line connecting the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia was measured. If the osteotomy line was positioned within an area 11.2 mm anterior to the reference line, it was considered to be inside the neurological safe zone. We correlated the positioning of the osteotomy with the presence of postoperative neurological complications. Results. We identified 179 calcaneal osteotomy cases. Of the 174 (97.2%) nerve injury-free cases, 62.6% (109/174) were performed inside the defined “safe zone” while 37.4% (65/174) outside. A total of 5 (2.8%) nerve complications were identified: 3 (60%) were inside the safe zone and 2 (40%) outside the safe zone. Osteotomies outside the safe zone had a 1.114 relative risk of nerve injury with a 95% CI of 0.191 to 6.500 and showed no statistically significant difference ( P = .9042). Conclusion. Our findings suggest that the clinical “safe zone” in calcaneal osteotomies may not actually exist, likely because of wide anatomical variation of the implicated nerves, as described in prior studies. Patients should be properly counseled preoperatively on the low, but seemingly fixed, risk of nerve injury before undergoing calcaneal osteotomy. Levels of Evidence: Level III: Retrospective comparative study

scholarly journals Calcaneal Osteotomy Safe-Zone to Prevent Neurological Damage

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Parke Hudson ◽  
Cesar de Cesar Netto ◽  
Bahman Sahranavard ◽  
Brent Cone ◽  
Ibukunoluwa Araoye ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Average Distance ◽  
Anatomical Variation ◽  
Retrospective Chart Review ◽  
Plantar Fascia ◽  
Safe Zone ◽  
Neurological Deficits ◽  
Nerve Injuries ◽  
Common Procedure ◽  
Calcaneal Osteotomy

Category: Ankle, Hindfoot Introduction/Purpose: Calcaneal osteotomy is a relatively common procedure used to address hindfoot deformities with a lateral calcaneal slide being utilized in the treatment of varus deformities and a medial slide for valgus deformities. This procedure does put neurological structures at risk. Specifically, a lateral approach jeopardizes the sural and lateral calcaneal nerves, while a medial approach endangers the medial plantar, lateral plantar, and calcaneal nerves. A previous cadaveric study described a neurological “safe zone” 11.2 mm anteriorly from “line A” which was described as extending from the posterior-superior aspect of the calcaneal tuberosity to the origin of the plantar fascia. We performed a retrospective chart review to correlate the positioning of the calcaneal osteotomy and the presence of neurological injuries. Methods: In this retrospective study, we reviewed charts of patients who underwent calcaneal osteotomy at our institution in the past 5 years (January 1, 2011 to December 31, 2015). All immediate postoperative radiographs were examined and the distance between the calcaneal osteotomy line and line A was measured. If this distance was less than 11.2 mm the osteotomy was defined as “inside the safe zone”, over 11.2 mm was defined as “anterior to safe zone”, and osteotomies posterior to line A were defined as “posterior to the safe zone”. We correlated the positioning of the osteotomy with the presence of postoperative neurological findings, including damage to the sural, calcaneal, or plantar nerves, presenting as paresthesias or numbness in the nerves’ distributions. Results: Overall, we identified 179 calcaneal osteotomy cases with adequate radiographs and follow-up for inclusion in our analysis. Seven patients experienced postoperative neurological deficits consistent with iatrogenic nerve injury. Of these patients, 28.6% (2/7) had osteotomies anterior to the safe zone with an average distance of 18.40 mm anterior to line A. The remaining 5 (71.4%) received osteotomies inside the safe zone, an average of 7.12 mm anterior to line A. Of the patients who did not sustain nerve injuries 36.0% (62/172) had osteotomies anterior to the safe zone with an average distance of 15.40 mm anterior to line A, 66.2% (107/172) were inside the safe zone with an average distance of 7.84 mm, and 1.7% (3/172) were posterior to the safe zone. Conclusion: Our findings suggest a clinical safe zone in calcaneal osteotomies may not actually exist. Although not statistically significant due to the low prevalence of nerve injury overall, a greater percent (71.4%) of patients with nerve injuries had their osteotomies performed within the safe zone when compared to neurologically intact postoperative patients (66.2%). This data may indicate the lack of a true safe zone, likely due to wide anatomical variation of the implicated nerves, as described in prior studies. Patients should be properly counseled preoperatively on the low, but seemingly fixed risk of nerve injury before undergoing calcaneal osteotomy.

Relationship Between the Lateral Plantar Artery and the Retrograde Intramedullary Nail During Tibiotalar and Subtalar Arthrodesis: A Fresh Cadaveric Study

2021 ◽  
pp. 193864002098668
Author(s):  
Ichiro Tonogai ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Safe Zone ◽  
Medullary Canal ◽  
Cadaveric Study ◽  
Entry Point ◽  
Medial Wall ◽  
Lateral Column ◽  
3 Dimensional ◽  
Retrograde Intramedullary Nail ◽  
Plantar Artery ◽  
Computed Tomography Scans

Background Tibiotalocalcaneal (TTC) arthrodesis with retrograde intramedullary nailing has become established. Iatrogenic injury to the vasculature (eg, lateral plantar artery [LPA] pseudoaneurysm) during insertion of the nail has been reported. The aim of this study was to identify the safe zone that avoids injury to the LPA during TTC arthrodesis. Methods The retrograde lateral curved nail entry point should be in line with the midpoint of the tibial medullary canal and the lateral column of the calcaneus. Enhanced 3-dimensional computed tomography scans of 26 fresh cadaveric feet were assessed. The closest distance between the LPA and the edge of the nail entry point was measured in the plantar view. Results The closest mean distance between the LPA and the edge of the nail entry point was 6.7 mm for all 26 feet, 12.8 mm for 3 feet (11.5%) in which the LPA did not cross the medial wall of the calcaneus, 8.1 mm for 9 (34.1%) in which the point where the LPA crossed the medial wall of the calcaneus was anterior to the center of the nail entry point, and 4.2 mm for 14 (53.8%) feet in which this point was posterior to the center of the nail entry point. Conclusions Care should be taken to avoid the LPA during reaming at the nail entry point, especially when the point where the LPA crosses the medial wall of the calcaneus is posterior to the center of the nail entry point. Levels of Evidence: IV, cadaveric study

The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study

2019 ◽  
Vol 13 (1) ◽  
pp. 69-73
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Sagittal Plane ◽  
External Iliac Artery ◽  
Cadaveric Study ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Branching Point ◽  
Enhanced Computed Tomography ◽  
Distal Direction

The anterior lateral malleolar artery (ALMA), which usually originates from the anterior tibial artery (ATA), courses transversely and laterally, passing under the extensor digitorum longus and peroneus tertius tendons. Variations in the origin of the ALMA from the ATA can occur. Branches of the ATA, such as the ALMA, are prone to pseudoaneurysm. This study reviewed the origin of the ALMA from the ATA and aimed to identify problems in anterior ankle arthroscopy that might cause injury to the ALMA. Enhanced computed tomography scans of 24 feet of 24 fresh cadavers (13 males, 11 females; average age 78.1 years) were assessed. The limb was injected with barium sulfate suspension through the external iliac artery; the origin of the ALMA from the ATA on the sagittal plane was recorded. The origin was at the ankle joint level in 4 specimens and below the ankle joint in 17 specimens. The distance from the ankle joint to the branching point of the ALMA on the sagittal plane was 5.2 mm distal to the joint. The level of origin of the ALMA from the ATA was established. Instruments should not be inserted from the distal direction when placing anterolateral portals. Levels of Evidence: Level IV, cadaveric study

Intraoperative angiography for visceral arteries originating from false lumen

2021 ◽  
pp. 021849232110414
Author(s):  
Shintaro Takago ◽  
Satoru Nishida ◽  
Yukihiro Noda ◽  
Yu Nosaka ◽  
Ryo Yamamura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
False Lumen ◽  
External Iliac Artery ◽  
Acute Type ◽  
Elephant Trunk ◽  
Intraoperative Angiography ◽  
Visceral Arteries ◽  
Enhanced Computed Tomography

A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

scholarly journals Dupuytren-Like Contracture of the Foot: Ledderhose Disease

2016 ◽  
Vol 02 (03) ◽  
pp. e102-e104 ◽  
Author(s):  
Osman Akdag ◽  
Gokce Yildiran ◽  
Mehtap Karamese ◽  
Zekeriya Tosun
Keyword(s):  
Treatment Options ◽  
Plantar Fascia ◽  
Plantar Aponeurosis ◽  
Steroid Injections ◽  
Medial Side ◽  
Disease Case ◽  
Ledderhose Disease ◽  
Plantar Incision ◽  
Plantar Fibromatosis ◽  
Slow Growing

Introduction Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.

Comparative Results of Percutaneous Calcaneal Osteotomy in Correction of Hindfoot Deformities

2018 ◽  
Vol 40 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Natalia Gutteck ◽  
Alexander Zeh ◽  
David Wohlrab ◽  
Karl-Stefan Delank
Keyword(s):  
Wound Healing ◽  
Standard Technique ◽  
Percutaneous Technique ◽  
Level Of Evidence ◽  
Calcaneal Osteotomy ◽  
Scale Scores ◽  
Oblique Incision ◽  
Hindfoot Deformities ◽  
Wound Healing Problems ◽  
The Difference

Background: Calcaneal osteotomies are often required in the correction of hindfoot deformities. The traditional open techniques, which include a lateral or oblique incision, are occasionally associated with wound healing problems and neurovascular injury. Methods: A total of 122 consecutive patients who underwent a calcaneal osteotomy for hindfoot realignment treatment were included. Fifty-eight patients were operated using an open incision technique and 64 patients (66 feet) using a percutaneous technique. Clinical and radiologic assessments were performed preoperatively, at 6 weeks, and 1 year postoperatively. Results: The American Orthopaedic Foot & Ankle Society scale scores and visual analog scale pain scores improved in both groups postoperatively. The difference between the groups was not significant. The results of the radiologic measurements pre- and postoperatively were not significantly different. No pseudarthrosis occurred in either group. The comparison of both groups showed a significantly lower risk for wound healing problems in the percutaneous group. The hospitalization time was significantly shorter in the percutaneous group. Conclusion: Because of the excellent results with the percutaneous calcaneal osteotomy, the authors feel encouraged to establish this procedure as a standard technique for calcaneus osteotomy, especially patients at high risk for wound healing problems. Level of Evidence: Level III, comparative series.

Examination of the Origin and Branching Direction of the Anterior Medial Malleolar Artery From the Anterior Tibial Artery: A Cadaveric Study

2018 ◽  
Vol 12 (2) ◽  
pp. 167-171 ◽  
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Sagittal Plane ◽  
External Iliac Artery ◽  
Longitudinal Axis ◽  
Cadaveric Study ◽  
Ankle Arthroscopy ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Branching Point

Background. This study characterized the anterior medial malleolar artery (AMMA) branching from the anterior tibial artery (ATA) to identify problems in anterior ankle arthroscopy possibly contributing to injury to the AMMA. Methods. Barium was injected into 12 adult cadaveric feet via the external iliac artery and the origin and branching direction of the AMMA were identified on computed tomography. Results. The AMMA originated from the level of the ankle joint and below and above the ankle joint line (AJL) in 4 (33.3%), 6 (50.0%), and 1 (8.3%) specimen, respectively. Mean distance from the AJL to the branching point of the AMMA on the sagittal plane was 2.5 mm distal to the AJL. Mean angle between the distal longitudinal axis of the ATA and AMMA was 83.2°. Conclusions. This study established the origin and branching of the AMMA from the ATA. The AMMA should be examined carefully during ankle arthroscopy. Levels of Evidence: Level IV: Cadaveric study

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