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Digital Vascular Mapping of the Integument About the Achilles Tendon

Yepes, Horacio, MD1; Tang, Maolin, MD2; Geddes, Christopher, MD, MSc2; Glazebrook, Mark, MD, FRCS(C)3; Morris, Steven F., MD, MSc, FRCS(C)4; Stanish, William D., MD, FRCS(C)3

doi: 10.2106/JBJS.I.00743
Scientific Articles

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Clinical Relevance: 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.

1Department of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, 1487 George Street, Sydney, NS B1P 1P2, Canada. E-mail address:

2Department of Anatomy and Neurobiology and Department of Surgery, Faculty of Medicine, Dalhousie University, Sir Charles Tupper Building, 13th Floor, Halifax, NS B3H 4H7, Canada

3Fenwick Medical Centre, 5595 Fenwick Street, Suite 311, Halifax, NS B3H 4M2, Canada

4QEII Health Sciences Centre, 1796 Summer Street, Room 4443, Halifax, NS B3H 3A7, Canada

Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated
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