Approaches for Ankle Arthrodesis
In a lot of patients, the soft tissue covering the foot and ankle includes small or no fatty tissue, and typically the soft tissue is abnormal because of previous trauma or surgery. The surgical strategy for arthrodesis ought to strive to avoid placing undue tension on the skin. When a skin flap is made, it should be as thick as possible to diminish the possibility of skin slough. An incision down to bone to create full-thickness skin flaps is suggested, if achievable, when operating by way of unstable or adherent skin; this may enable prevent skin slough.
The cutaneous nerves around the foot and ankle typically are superficial and may easily be cut, caught up inside scar tissue, or stretched at the time of surgery. The place of these nerves ought to be kept in thoughts when approaching the ankle for arthrodesis, but avoiding all cutaneous nerves embedded in scar is impossible in numerous instances.
Anterior Strategy
An anterior approach, usually by means of the anterior tibial tendon sheath, makes it possible for exposure of your complete ankle joint, but limits access towards the medial and lateral malleoli. An anterolateral method inside the internervous plane among the superficial peroneal and sural nerves, with or devoid of fibular osteotomy, gives great exposure of your ankle joint and can be extended distally to expose the subtalar joint; nevertheless, access for the medial malleolus is restricted, and an additional tiny anteromedial incision could be necessary.
Transmalleolar (Transfibular) Approach
A transmalleolar or transfibular method offers exposure equivalent to that of your anterolateral method, but makes it possible for slightly improved access towards the posterior aspect from the ankle joint. Exposure is enhanced by medial and lateral transmalleolar osteotomies. Combining medial and lateral incisions offers full exposure of the joint and permits removal of your malleoli if desired for cosmesis or reduction of deformity. Paremain, Miller, and Myerson described a ¡°miniarthrotomy¡± strategy, in which two 1.5-cm incisions are utilized, 1 medial and a single anterolateral.
Posterior Method
The posterior strategy might be employed for isolated tibiotalar fusion in patients with compromised anterior skin from preceding trauma or surgery. It can be used extra typically, having said that, for tibiotalar calcaneal arthrodesis, as described by Campbell and Russotti et al. Hayes and Nadkarni described an extensile posterior approach for the ankle according to an extraarticular vertical calcaneal osteotomy behind the subtalar joint; the plane of dissection follows an internervous plane behind the fibula. Based on the authors, the posterior flap formed is hinged medially and presents wide exposure towards the back from the ankle and posterior subtalar joint. They reported no wound healing problems in 12 patients with osteoarthritis or rheumatoid arthritis.
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