The lateral calcaneal artery was found 1.61±1.03 cm posterior to the proximal end of the STA, 0.68±0.23 cm anterior to the proximal end of the LEA, and 2.50±0.91 cm anterosuperiorto the apex of the LEA. We also used the lateral calcaneal artery as a recipient pedicle in foot reconstruction without sacrificing the main circulation in two clinical cases. It has been used successfully in five patients. The first medial calcaneal branch may emanate from the end of the posterior tibial artery as well. A lateral calcaneal artery skin flap is an axial pattern flap that includes the lateral calcaneal artery, lesser saphenous vein and the sural nerve.2) Since its de- Previous studies showed a calcaneal branch of the peroneal artery contributing to the calcaneal flap blood supply. Lateral calcaneal artery adipofascial flaps are limited in size but can fill defects of the posterior heel. The lateral calcaneal artery as an alternative recipient vessel option for heel and lateral foot reconstruction Kyong‐Je Woo MD Department of Plastic Surgery, College of Medicine, Ewha Womans University, Seoul, South Korea Similarly, the leg is conceptualized as having at least three angiosomes, one for each of the major vessels (the anterior and posterior tibial and the fibular arteries). The Lateral Calcaneal ( ramus calcaneus lateralis; external calcaneal) are the terminal branches of the peroneal artery; they pass to the lateral side of the heel, and communicate with the lateral malleolar and, on the back of the heel, with the medial calcaneal arteries. Moreover, their softness and pliability make them suitable for filling the subcutaneous spaces formed by debridement. It connects the gastrocnemius and soleus muscles in the calf to an insertion point at the calcaneus (heel bone). LCA. 2 Foot & Ankle International Anatomical research has allowed exploration of its many advantages but can also lead to its various modifications, permitting a wide variety of clinical applications. Photograph showing three medial calcaneal arteries (MCAs) branching from the lateral plantar artery (LPA) in a left foot. Lateral calcaneal flap vascularization and innervations are based on lateral calcaneal artery neurovascular bundle, that is, lateral calcaneal artery, small saphenous vein, and sural nerve. A lateral calcaneal artery (LCA) flap was first described in 19811 It was an axial pattern flap . The posterior calf fascial free flap. R.E. The LCA was found significantly closer to … The lateral calcaneal artery is responsible for the majority of the blood supply to this area. The lateral plantar artery and its branches supply the adjoining muscles, and the skin and subcutaneous tissues on the lateral side of the sole. The lateral calcaneal artery fasciocutaneous transpositional flap is utilized for coverage in a case presentation of a 6-year-old child with an insensate posterior heel defect. The lateral calcaneal artery skin flap(the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap). Lateral calcaneal artery: It’s a terminal branch which takes part in the formation of lateral malleolar plexus. The purpose of the present study was to analyze our long-term results of lateral calcaneal artery flap transfer for hindfoot reconstruction. Medial plantar sensory flap for coverage of heel defects. Traditionally, the vertical limb has been placed half-way between the fibula and Achilles tendon, which may be suboptimal given the proximity to the LCA. This study aimed to investigate the course of the LCA and to define anatomical points that can be used by surgeons during lateral approaches to the calcaneus. The lateral calcaneal artery (arrow) was a branch of the peroneal artery and connected with lateral malleolar artery. Plast Reconstr Surg. calcaneal arteries provided by the lateral plantar artery. The diameters at the level of the calcaneus were 1.3 mm and 1.5 mm, respectively. However, the operative wound complication rate is high. Surgical technique With the patient lying in the decubitus position, an imaginary line was drawn from lateral malleolous to the heel. We postulated that patency of the LCBP artery may have a profound positive impact on incisional wound healing for calcaneal open reduction and internal fixation (ORIF). Keywords: lateral calcaneal artery, extensile lateral approach, modified extensile lateral approach, calcaneus fracture, operative technique, wound complications Downloaded from fai.sagepub.com by CHARLES M LOMBARDI on November 8, 2016. Click to see full answer. Journal of Orthopaedic Trauma. The lateral calcaneal ar-tery which is a branch from the peroneal artery was the main blood supply to the apex of the flap. The lateral calcaneal artery (arrow) was a branch of the peroneal artery and connected with lateral malleolar artery. Iatrogenic injury to the vasculature (eg, lateral plantar artery [LPA] pseudoaneurysm) during insertion of the nail has been reported. All patients have protective sensation on the flap area, and 7 ambulatory patients can … A branch of the posterior tibial artery; it runs in the back of the lateral side of the leg, between the tibialis posterior and flexor hallucis longus muscles. A lateral calcaneal artery skin flap is an axial pattern flap that includes the lesser saphenous vein, the sural nerve and the lateral calcaneal artery9,10. Lateral calcaneal artery flap has been occasionally described for posterior non weight bearing defects in literature. We have not yet used the heel pad In 2 of the 10 specimens the lateral calcaneal artery and the lateral calcaneal arch were supplied by an additional larger peroneal branch. The lateral calcaneal artery flap provides a simple and reliable option for reconstructing the posterior heel defect. What bones make up the tarsal? The lateral calcaneal artery flap provides a simple and reliable option for reconstructing the posterior heel defect. The lateral plantar artery gives off muscular branches, superficial branches, anastomotic branches and a calcaneal branch. Borrelli, Joseph Jr; Lashgari, Cyrus. The calcaneus is an irregular, roughly cuboidal bone sitting below the talus. Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. The flap can be designed as a short (8.0 X 4.5 cm in the adult) vertical flap or a long (14.0 X 4.5 cm) flap that curves forward to the base of the fifth metatarsal. These flaps do not require the sacrifice of a major artery to the leg or foot, they are relatively thin with minimal morbidity at the donor site, and leave a simple linear scar over the lateral aspect of the foot. The lateral calcaneal artery as an alternative recipient vessel option for heel and lateral foot reconstruction Kyong‐Je Woo MD Department of Plastic Surgery, College of Medicine, Ewha Womans University, Seoul, South Korea that included LCA, lesser saphenous vein, and su-ral nerve and proved to provide both effective and What bones make up the tarsal? The lateral calcaneal artery is a branch of the anterior tibial artery which crosses over the calcaneal tuberosity and forms a large lateral arch with the lateral tarsal artery which is a … The extensile lateral approach (EL) has been associated with increased wound complications such as apical necrosis which may be due partially from violation of the lateral calcaneal artery (LCA). The diameters at the level of the calcaneus were 1.3 mm and 1.5 mm, respectively. The dorsal part of the calcaneus is circular and provides the attachment site for the calcaneal tendon (Achilles tendon) posteriorly at the calcaneal notch and facilitates weight bearing inferiorly at the calcaneal tuberosity. The lateral calcaneal artery, lesser saphenous vein and sural nerve all lie on the deep surface of the subcutaneous tissue. The perforators arising from the lateral popliteal cutaneous artery (1) were anastomosed with the perforators of the peroneal artery … The procedural technique and 32-month follow-up is described. 1 It was an axial pattern flap that included LCA, lesser saphenous vein, and sural nerve and proved to provide both effective and reliable posterior heel coverage. The lateral calcaneal artery adipofascial flap is a modification of the lateral calcaneal artery skin flap. Plast Reconstr Surg. The study also measured the relation of the lateral calcaneal artery to bony landmarks of the hindfoot. The main source is the tibialis pos- terior artery (tp) and the dorsalis pedis artery (dp). Background: Soft tissue defects over posterior heel are difficult to cover especially in patient with difficult health issues under general anaesthesia.. 15 Indications The extended lateral approach to the calcaneus is the most common approach used for displaced intraarticular calcaneal fractures. Over 90% of calcaneal fractures with displaced joint fragments can be serviced by this approach. The calcaneus can present with an enormous variety of fracture configurations. 1. (1985). The vascular territory (angiosome) of the lateral foot is now known to be dependent upon the lateral calcaneal branch of the peroneal artery (LCBP artery). The lateral calcaneal artery skin flap is an axial-pattern flap that can provide skin flap coverage over the exposed calcaneal tendon or os calcis on the posterior or plantar heel. In our 10 cases including 3 diabetic patients, there was no flap necrosis, but one had the problem of wound healing. Its … Direct clo- 2. Google Scholar. Grabb W. C.and Argenta L. C. The Lateral This is important particularly in women. Traditionally, the vertical limb has been placed half-way between the fibula and Achilles tendon, which may be suboptimal given the proximity to the LCA. The calcaneus is an irregular, roughly cuboidal bone sitting below the talus. that included LCA, lesser saphenous vein, and su-ral nerve and proved to provide both effective and The lateral calcaneal artery skin flap is an axial-pattern flap that can provide skin flap coverage over the exposed calcaneal tendon or os calcis on the posterior or plantar heel. Varun Singh Chauhan and Shobhit Gupta. The lateral calcaneal artery is a branch of the anterior tibial artery which crosses over the calcaneal tuberosity and forms a large lateral arch with the lateral tarsal artery which is a branch of the dorsalis pedis artery.   The lateral plantar artery and its branches supply the adjoining muscles, and the skin and subcutaneous tissues on the lateral side of the sole. Lateral calcaneal flap vascularization and innervations are based on lateral calcaneal artery neurovascular bundle, that is, lateral calcaneal artery, small saphenous vein, and sural nerve. It connects the gastrocnemius and soleus muscles in the calf to an insertion point at the calcaneus (heel bone). In another case, … In comparison to the skin flap, it has the advantages of more versatile clinical applications, better aesthetic result of the donor site and sural nerve preservation. It also anastomoses w/ … A lateral calcaneal artery (LCA) flap was first described in 1981. Conclusions: Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. The heel pad is mostly supplied from the posterior tibial artery branches medially. The lateral calcaneal artery appeared to be responsible for the majority of the blood supply to the corner of the flap and, because of its proximity to the vertical portion of the typical incision, it appeared most likely to be injured from inaccurate placement of the incision. It projects posteriorly to form the core of the heel. We have, however, noted small veins subcutaneously in this area and these should be preserved. They perforate the flexor retinaculum and supply the skin over the calcaneal tendon and calcaneus, and the muscles of the medial part of the sole of the foot. The flap can be designed as a short (8.0 X 4.5 cm in the adult) vertical flap or a long (14.0 X 4.5 cm) flap that curves forward to the base of the fifth metatarsal. The lateral calcaneal artery is responsible for the majority of the blood supply to the corner of the L-shaped flap of this approach. Peroneal vessels are last to be affected by age, Diabetes mellitus or smoking, making it a safe flap. We also used the lateral calcaneal artery as a recipient pedicle in foot reconstruction without sacrificing the main circulation in two clinical cases. These angiosomes include the distributions of the medial and lateral plantar and the dorsalis pedis arteries, as well as the medial and lateral calcaneal artery distributions. Surgical technique With the patient lying in the decubitus position, an imaginary line was drawn from lateral malleolous to the heel. The lateral plantar artery gives off muscular branches, superficial branches, anastomotic branches and a calcaneal branch. Figure 7.63 (A) Diagram of the lateral calcaneal blood supp . The calcaneus lateral view is part of the two view calcaneus series; this projection is used to assess the calcaneus, talocrural, talonavicular and talocalcaneal joint.. As technology advances, computed tomography (CT) has widely been used 1 to better visualize and characterize calcaneum fragment displacements and fracture lines. The retrograde … Lateral calcaneal artery adipofascial flaps are limited in size but can fill defects of the posterior heel. The Anatomic and clinical study focused on lateral calcaneal artery course and optimization of surgical technique for flap harvesting and results were satisfactory in terms of coverage adequacy, perioperative morbidity, and functional and aesthetical outcome. LMA. The posterior part of the calcaneus is circular, with three facets (superior, middle and inferior). - these authors found three consistent arteries around the lateral aspect of the hindfoot (lateral calcaneal artery, lateral malleolar artery, and the lateral tarsal artery); - these authors warn against placing the verticle limb too far anteriorly (or it will disrupt the lateral calcaneal artery); A lateral calcaneal artery (LCA) flap was first described in 1981. In another case, the skin graft over the flap donor site failed to take. This small incision is much safer than the extended L-incision. The lateral calcaneal artery is a branch of the anterior tibial artery which crosses over the calcaneal tuberosity and forms a large lateral arch with the lateral tarsal artery which is a branch of the dorsalis pedis artery. Deep peroneal and accessory deep peroneal when present. The Achilles tendon is a thick tendon located in the back of the leg. The lateral aspect of the heel is supplied by the posterior peroneal or the posterior tibial artery. Yet, there remain many institutions … A total of four patients (average age, 48 years) underwent lateral calcaneal artery flap transfer. The aim of this study was to identify the safe zone that avoids injury to the LPA during TTC arthrodesis. Its long axis is oriented along the midline of the foot, however deviates lateral to the midline anteriorly. Moreover, their softness and pliability make them suitable for filling the subcutaneous spaces formed by debridement. Tibiotalocalcaneal (TTC) arthrodesis with retrograde intramedullary nailing has become established. The tarsal bones are 7 in number. Gingrass. They supply the skin over the lateral side of the calcaneal tendon and the calcaneus. Use of the lateral calcaneal artery skin flap for heel reconstruction has been reported since 1981.6., 7., 8. The lateral calcaneal artery skin flap is an axial-pattern flap that can provide skin flap coverage over the exposed calcaneal tendon or os calcis on the posterior or plantar heel. It projects posteriorly to form the core of the heel. Photograph of the right ankle region (D) showing a single medial calcaneal artery (MCA) branching from the lateral plantar artery (LPA). The lateral circumflex femoral artery is a branch of the profunda femoris artery that arises from its lateral aspect just after the medial circumflex femoral artery.. PTA: Posterior tibial artery, MPA: medial plantar artery. The proximity of the lateral calcaneal artery (LCA) to surgical incisions applied to the lateral hindfoot makes it vulnerable to iatrogenic injury and subsequent postoperative skin necrosis. 723-730. 34, 35 The EHBm sits medial to the EDBm and originates from the dorsolateral aspect of the calcaneus and inserts onto the dorsal base of the proximal phalanx of the great toe. The sural nerve needs to be protected in the horizontal part of the approach. It is based one the angiosome of the lateral calcaneal artery, a terminal branch of the peroneal artery. The lateral calcaneal artery skin flap (the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap) Plast Reconstr Surg, 68 (1981), pp. LTA. A smaller supp y is delivered via the peroneal artery (p) which is lost amid the lateral malleolar net. Vascularity of the Lateral Calcaneal Flap: A Cadaveric Injection Study . Clinical Significance. The tarsal bones are 7 in number. The posteromedial compartment, in order of anterior to posterior has the tendons of tibialis posterior and flexor digitorum longus, the posterior tibial artery, the tibial nerve and flexor hallucis longus tendon. The lateral calcaneal artery flap provides a simple and reliable option for reconstructing the posterior heel defect. lateral calcaneal artery is responsible for corner of flap careful attention to skin handling and closure with Allgower-Donati suture technique minimizes soft tissue complications Please rate topic. The distally based lateral calcaneal flap has been successfully used in 2 patients. The posterior part of the calcaneus is circular, with three facets (superior, middle and inferior). It runs along the __ aspect of heel & provides an important connection between the __ __ __ branch of anterior tibial artery & __ __ __ branches of peroneal. Posterior tibial artery (the lateral calcaneal branch comes off the peroneal artery) What nerve gives dorso-medial cutaneous innervation to the 3rd toe? The lateral calcaneal artery is responsible for the majority of the blood supply to the corner of the L-shaped flap of this approach. The heel pad is mostly supplied from the posterior tibial artery branches medially. The sural nerve needs to be protected in the horizontal part of the approach. lateral calcaneal branch terminal branch of the peroneal artery provides perfusion to the lateral flap associated with a standard extensile approach to the calcaneus Lateral calcaneal flap is an established surgical option for coverage of lateral calcaneum and posterior heel defects. When the Calcaneal Artery Flap, Plastic Reconstruc- donor area is closed directly, the final result is aes- tive Surgery 1985, 68: 723 thetically more acceptable (Fig 8 and 9). In our cadaver dissection, the connection between the lateral calcaneal artery, the lateral tarsal artery, and the branch of the lateral plantar artery was corroborated, indicating possible reverse blood flow in the lateral calcaneal artery. Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. 21. peroneal artery: [TA] origin , posterior tibial; distribution , courses deep to the flexor hallucis longus, supplying it and the soleus, tibialis posterior, fibularis muscles, inferior tibiofibular articulation, ankle joint, and lateral heel; anastomoses , anterior lateral malleolar, lateral tarsal, lateral plantar, dorsalis pedis. The lateral half of the posterior joint surface was supplied by the lateral calcanear artery. Its long axis is oriented along the midline of the foot, however deviates lateral to the midline anteriorly. The lateral circumflex femoral artery is a branch of the profunda femoris that arises from its lateral aspect just after the medial circumflex femoral artery.. The Lateral Calcaneal (ramus calcaneus lateralis; external calcaneal) are the terminal branches of the peroneal artery; they pass to the lateral side of the heel, and communicate with the lateral malleolar and, on the back of the heel, with the medial calcaneal arteries. The calcaneal branches arise just proximally to the terminal bifurcation of the posterior tibial artery. In our 10 cases including 3 diabetic patients, there was no flap necrosis, but one had the problem of wound healing. • Lateral calcaneal artery (LCA) • Lateral malleolar artery (LMA) • Lateral tarsal artery (LTA) • Sural nerve and peroneal tendons at risk with lateral dissection. The extensile lateral approach (EL) has been associated with increased wound complications such as apical necrosis which may be due partially from violation of the lateral calcaneal artery (LCA). Figure 11. In the five patients described in this report, lateral calcaneal artery adipofascial flaps were used to effectively cure intractable defects with minimal … Calcaneal branches: arise as terminal branches of the fibular artery and pass to the lateral side of the calcaneus to anastomose with the calcaneal branches of the posterior tibial artery. While the medial circumflex runs posteriorly around the femoral neck, the lateral circumflex courses laterally from its origin and anterior to the femoral neck. The flap is nourished by the lateral calcaneal artery, which is a terminal branch of the peroneal artery, is drained by the lesser saphenous vein, and is innervated by the sural nerve. Shanahan, R.P. Lateral calcaneal artery (LCA) flap originally described by Grabb and Argenta in 1981 is axial pattern Fasciocutaneous flap that includes the LCA, short saphenous vein (SSV) and the sural nerve. A lateral calcaneal artery skin flap is an axial pattern flap that includes the lateral calcaneal artery, lesser saphenous vein and the sural nerve. The Achilles tendon is a thick tendon located in the back of the leg. (T/F) The lateral calcaneal artery is considered, by some, as terminal branch of peroneal artery. The lateral malleolar net-work is formed by the anterior lateral malleolar branch of the anterior tibial, the lateral tarsal branch of the dorsalis pedis, the perforating and the lateral calcaneal branches of the peroneal, and twigs from the lateral plantar artery. In another case, the skin graft over the flap donor site failed to take. The peroneal artery subdivides into the perforating artery, the posterior lateral malleolar artery, and the lateral calcaneal artery. BACKGROUND: The extensile lateral calcaneal approach is a standard method for accessing a joint depression calcaneal fracture. Medial dorsal cutaneous n. What innervates the EDB/EHB? The extended lateral approach affords excellent visualisation of the components of the injury that require reduction, namely the lateral wall, subatalar and Calcaneo-cuboid joints and peroneal tendons. A lateral calcaneal artery (LCA) flap was first described in 19811 It was an axial pattern flap . 1 It was an axial pattern flap that included LCA, lesser saphenous vein, and sural nerve and proved to provide both effective and reliable posterior heel coverage. There is an anterolateral, posteromedial and lateral compartment of the ankle typically superficial to the joint.

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