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- Title
Soft tissue micro-circulation in the healthy hindfoot: a cross-sectional study with focus on lateral surgical approaches to the calcaneus.
- Authors
Carow, John Bennet; Carow, Juliane; Gueorguiev, Boyko; Klos, Kajetan; Herren, Christian; Pishnamaz, Miguel; Weber, Christian David; Nebelung, Sven; Kim, Bong-Sung; Knobe, Matthias
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
HEEL bone; SOFT tissue injuries; BLOOD flow; WOUND healing; BLOOD pressure; FOOT surgery; HEEL bone injuries; FOOT; FRACTURE fixation; BONE fractures; MICROCIRCULATION; ORTHOPEDIC implants; OXYGEN; PILOT projects; TREATMENT effectiveness; HUMAN research subjects; CROSS-sectional method
- Publication
International Orthopaedics, 2018, Vol 42, Issue 11, p2705
- ISSN
0341-2695
- Publication type
journal article
- DOI
10.1007/s00264-018-4031-7