Soft tissue micro-circulation in the healthy hindfoot: a cross-sectional study with focus on lateral surgical approaches to the calcaneus
- 194 Downloads
Open reduction and internal fixation (ORIF) using an extended lateral approach combined with plate osteosynthesis represents the current gold standard in calcaneal fracture treatment, but it is associated with a wound complication rate of up to 30%. Literature suggests that micro-circulation is one of the key factors for sufficient wound healing. The aim of this study was to evaluate soft tissue micro-circulation of the hindfoot in healthy volunteers to determine influencing factors and to identify hypoxic or hypoperfused areas in non-trauma situations, with special attention to surgical approaches.
Micro-circulation of the lateral hindfoot of 125 participants was non-invasively measured at 2 and 8 mm depths, utilizing a Micro-Lightguide O2C® spectrophotometer. Blood flow (BF [AU]) and oxygen saturation (SO2 [%]) of ten measurement points (MPs) were documented. Demographic factors (age, gender, body mass index [BMI], systolic/diastolic blood pressure, smoking, and pack-years) and regional differences with special regard to surgical approaches (extended lateral approach, Palmer approach, Ollier approach, and a self-modified extended lateral approach) were analyzed.
The SO2 assessments at 2- and 8-mm depths revealed higher values in males (p = 0.043; p = 0.025). There was a correlation between higher age and lower 2 mm BF (p = 0.044). Smoking history and number of pack-years did not predict micro-circulation. BF at the 2 mm depth was highest in the regions of Palmer and Ollier approach (p < 0.001). The MP at the distal calcaneal tuberosity showed significantly higher values regarding all parameters (SO2 (2 mm), p < 0.001; SO2 (8 mm), p = 0.001; BF (2 mm), p < 0.001; BF (8 mm), p < 0.001), compared to the surrounding area.
In non-trauma situations, young males were associated with better micro-circulatory supply of the lateral hindfoot. There was a trend for higher blood flow in regions of the Palmer and Ollier approach. The distal calcaneal tuberosity was clearly superior in all micro-circulatory parameters when compared to the surrounding area.
KeywordsO2C Micro-circulation Blood flow Soft tissue Hindfoot Calcaneus Surgical approach Wound complication
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics committee of the RWTH Aachen University Hospital, ethics approval EK 346/14.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with the ethical principles of research, and that informed consent for participation in the study was obtained.
- 2.Böhler L (1931) Diagnosis, pathology, and treatment of fractures of the os calcis. J Bone Joint Surg Am 13:75–89Google Scholar
- 5.Sanders R, Fortin P, DiPasquale T, Walling A (1993) Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res (290):87–95Google Scholar
- 6.Zwipp H, Tscherne H, Wülker N, Grote R (1989) Intra-articular fracture of the calcaneus. Classification, assessment and surgical procedures. Unfallchirurgie 92(3):117–129Google Scholar
- 11.Rammelt S, Zwipp H (2014) Fractures of the calcaneus: current treatment strategies. Acta Chir Orthop Traumatol Cechoslov 81(3):177–196Google Scholar
- 20.Letournel E (1993) Open treatment of acute calcaneal fractures. Clin Orthop Relat Res (290):60–67Google Scholar
- 21.Zwipp H, Tscherne H, Thermann H, Weber T (1993) Osteosynthesis of displaced intraarticular fractures of the calcaneus results in 123 cases. Clin Orthop Relat Res 290:76–86Google Scholar
- 23.Burdeaux BD (1983) Reduction of calcaneal fractures by the McReynolds medial approach technique and its experimental basis. Clin Orthop Relat Res 177:87–103Google Scholar
- 35.Harrison DK, McCollum PT, Newton DJ et al (1995) Amputation level assessment using lightguide spectrophotometry. Prosthetics Orthot Int 19(3):139–147Google Scholar
- 41.Forstmeier V, Sorg H, Kabbani M et al (2015) Evaluation of cutaneous microcirculation at the dorsum of the hand within different age groups—implications for wound healing in hand surgery? Handchir Mikrochir Plast Chir 47(6):384–388. https://doi.org/10.1055/s-0035-1555868 CrossRefPubMedGoogle Scholar
- 48.Woo S, Bae S, Chung HJ et al (2017) Radiologic and clinical outcomes of Ollier approach with screw fixation for displaced intra-articular calcaneal fractures—comparative study with extensile lateral approach with lateral plating. Foot & Ankle Orthopaedics 2(3):2473011417S0004. https://doi.org/10.1177/2473011417S000412 CrossRefGoogle Scholar