title: Proximity of the Lateral Calcaneal Artery With a Modified Extensile Lateral Approach Compared to Standard Extensile Approach.
abstract: BACKGROUND
  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). 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. We hypothesized that placing the vertical limb further posterior (ie, modified EL [MEL]) would increase the distance from the LCA. The purposes of this study were to quantify the location of the LCA in relation to the vertical limb of the traditional EL approach and to determine if utilizing the MEL approach endangered the LCA to a lesser extent.
  
  
  METHODS
  20 cadavers were used. For the EL approach, the fibula and Achilles tendon were palpated and a line parallel to the plantar foot was drawn between the two. A vertical line (VL), representing the vertical limb of the approach, was drawn at the midway point as a perpendicular extending proximally from the junction of the glabrous/non-glabrous skin (JGNG). For the MEL approach, the anterior border of the Achilles tendon was palpated and a similar vertical line (MVL) was drawn 0.75 cm anterior. Dissection was performed and if the LCA was identified crossing the line VL/MVL, the distance from the JGNG was documented.
  
  
  RESULTS
  For the EL approach, the LCA was identified in 17/20 (85%) cadavers at an average distance of 5.0 cm (range 3-7 cm, SD = 1.3 cm) from JGNG. For the ML approach, the LCA was identified in 4/20 (20%) cadavers at an average distance of 5.9 cm (range 3-6.5 cm, SD = 1.7 cm) from the JGNG ( P < .001).
  
  
  CONCLUSIONS
  The LCA was encountered 4 times more often during the EL approach as compared to the MEL approach.
  
  
  CONCLUSIONS
  A modification of the EL approach may decrease iatrogenic injury to the LCA and may decrease wound complications.
authors.affiliation: 1 Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: John Y
authors.initials: JY
authors.lastname: Kwon
authors.affiliation: 2 Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Gonzalez
authors.affiliation: 2 Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Riedel
authors.affiliation: 1 Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ara
authors.initials: A
authors.lastname: Nazarian
authors.affiliation: 1 Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ghorbanhoseini
mesh_terms: D000125:Achilles Tendon / Q000503:physiopathology*; D001158:Arteries / Q000293:injuries* / Q000503:physiopathology; D002102:Cadaver; D002111:Calcaneus / Q000293:injuries* / Q000503:physiopathology; D005360:Fibula / Q000503:physiopathology*; D005528:Foot; D006801:Humans
keywords: calcaneus fracture; extensile lateral approach; lateral calcaneal artery; modified extensile lateral approach; operative technique; wound complications