Journal Club
Acta Orthop Belg. 2011 Jun;77(3):355-61.
The anterolateral incision for pilon fracture surgery: an anatomic study of cutaneous blood supply.
Fisher BE, Nathan ST, Acland RD, Roberts CS.
Source
University of Louisville School of Medicine, Louisville, KY, USA.
Abstract
The purpose of this study was to examine the blood supply to the adjacent skin and its vulnerability to anterolateral tibial plating performed with fibular plating through a single surgical incision. Ten lightly embalmed cadaver legs without a history of lower extremity trauma or surgery with a mean age of 71 years (range, 57 to 87 years) were used for this investigation. Each specimen was injected with a commercially available silicone compound through the popliteal artery. The left leg was plated through a modified extensile Böhler approach and the right leg served as the control. Each leg was anatomically dissected. All measurements were taken using a digital caliper by a single investigator. A mean of 93 (range, 4 to 17) perforating arteries were present and in the proximity of the fibula plate. Our findings suggest the potential for iatrogenic soft tissue breakdown along the posterior border of the anterolateral surgical incision in this procedure as a result of compromised blood supply to the skin
congratulations to our editor, Senthilnathan for this paper. Now this paper is important for various reasons.
1. the anterolateral approach for distal tibia plating has gained popularity over the years because of its simultaneous access to the fibula and the ability to recontruct the articular surface better.
2. the study emphasises the watershed zone of the distal leg.
Senthil please give a short description of your study for the benefit of orthopaedic residents:-
Thanks Hitesh.
With advent more open reduction and fixation for distal pilon fractures, with a siongle incision approach becoming more popular now a days , this basic research paper was a significant read through to get a clear understanding of the vascular maps of the distal leg. The paper adds importtance on the integrity to preserve the vascular channels and also illustrates the clear demarcation of the anatomical boundaries of each feeder supply. This paper also a good guide for plastic surgeons and orthopaedic surgeons who does a lot of flaps or wound cover in the distal aspect of the tibia.