Article

Cincinnati Incision Approach for Posterior Ankle and Calcaneal Pathology: Technique Tip

Wolfson Medical Center, Department of Orthopedics, Holon, Israel.
Foot & Ankle International (Impact Factor: 1.63). 01/2011; 32(1):92-4. DOI: 10.3113/FAI.2011.0092
Source: PubMed
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    ABSTRACT: We are describing a transverse incision that we have found useful in performing surgical procedures involving extensive dissection of the posterior, medical, and lateral aspects of the foot and ankle. Operative procedures using this incision have been performed on 154 feet in ninety-nine patients who were less than fifteen years old and who had an average follow-up of eighteen months. The incision is transverse and extends from the anteromedial to the anterolateral aspect of the foot over the back of the ankle at the level of the tibiotaler joint. Depending on the requirements of the procedure, either the anteromedial or posterolateral portion of the incision, or the complete incision, may be used. The incision improves visualization of the medial, posterior, and lateral aspects of the foot and ankle, while at the same time resulting in excellent healing of the wound and an improved cosmetic appearance compared with the more commonly used vertical incisions.
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    ABSTRACT: We have recently described an extended lateral approach to the hindfoot for the operative treatment of displaced intra-articular fractures of the calcaneum. It has the advantage of avoiding damage to the sural nerve and preserving blood supply to allow prompt healing. We dissected 15 formalin-preserved cadavers, taking photographs to show the structures of the posterolateral aspect of the hindfoot and ankle. We describe a superficial and a deep triangle: the deep triangle contains a constant posterior peroneal artery which supplies the skin of the posterolateral heel. An approach designed to expose the sural nerve will divide this important artery and cause ischaemia of the posterior skin. The extended lateral approach elevates the sural nerve in a thick flap and preserves the blood supply of the skin. We have reviewed 150 consecutive patients after the use of this approach to study the indications for operation, the quality of wound healing, any damage to the sural nerve and other complications. We recommend the careful use of this approach. Our understanding of its anatomical basis has allowed us to widen the indications for its use.
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    ABSTRACT: A retrospective review of 24 patients with dorsal incisions for open reduction and internal fixation of Frykman VII/VIII distal radius fractures using a dorsal plate was performed. Half of them had a longitudinal incision while the other half had a T-shaped incision. No difference in the healing properties or wound morbidity could be demonstrated between the two groups. However, the T incision provided improved exposure of the distal radius and patient satisfaction with its cosmetic result was superior. The horizontal limb was well camouflaged within the transverse skin crease on the dorsal aspect of the wrist. The vertical limb did not extend into the dorsum of the hand and could, therefore, be hidden by appropriate clothing.
    The Journal of Hand Surgery British & European Volume 01/2004; 28(6):568-70. DOI:10.1016/S0266-7681(03)00171-2 · 0.04 Impact Factor

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