Attinger CE, Evans KK, Bulan E, Blume P, Cooper P, et al.
Plastic and reconstructive surgery. Date of publication 2006 Jun 1;volume 117(7 Suppl):261S-293S.
1. Plast Reconstr Surg. 2006 Jun;117(7 Suppl):261S-293S.
Angiosomes of the foot and ankle and clinical implications for limb salvage:
reconstruction, incisions, and revascularization.
Attinger CE(1), Evans KK, Bulan E, Blume P, Cooper P.
Author information:
(1)Limb Center, Georgetown University Medical Center, Washington, DC 20007, USA.
cattinger@aol.com
BACKGROUND: Ian Taylor introduced the angiosome concept, separating the body into
distinct three-dimensional blocks of tissue fed by source arteries. Understanding
the angiosomes of the foot and ankle and the interaction among their source
arteries is clinically useful in surgery of the foot and ankle, especially in the
presence of peripheral vascular disease.
METHODS: In 50 cadaver dissections of the lower extremity, arteries were injected
with methyl methacrylate in different colors and dissected. Preoperatively, each
reconstructive patient's vascular anatomy was routinely analyzed using a Doppler
instrument and the results were evaluated.
RESULTS: There are six angiosomes of the foot and ankle originating from the
three main arteries and their branches to the foot and ankle. The three branches
of the posterior tibial artery each supply distinct portions of the plantar foot.
The two branches of the peroneal artery supply the anterolateral portion of the
ankle and rear foot. The anterior tibial artery supplies the anterior ankle, and
its continuation, the dorsalis pedis artery, supplies the dorsum of the foot.
Blood flow to the foot and ankle is redundant, because the three major arteries
feeding the foot have multiple arterial-arterial connections. By selectively
performing a Doppler examination of these connections, it is possible to quickly
map the existing vascular tree and the direction of flow.
CONCLUSIONS: Detailed knowledge of the vascular anatomy of the foot and ankle
allows the plastic surgeon to plan vascularly sound reconstructions, the foot and
ankle surgeon to design safe exposures of the underlying skeleton, and the
vascular surgeon to choose the most effective revascularization for a given
wound.
DOI: 10.1097/01.prs.0000222582.84385.54
PMID: 16799395 [Indexed for MEDLINE]
