Digital vascular mapping of the integument about the Achilles tendon

Background: Soft-tissue coverage and vascularity likely play a vital role in the genesis of wound complications and infections during open Achilles tendon repair. Planning an appropriate surgical approach might decrease the prevalence of these complications. Methods: Five adult cadavers underwent whole-body arterial perfusion with a mixture of lead oxide, gelatin, and water. The skin of the foot and ankle was dissected, and the vascular supply was evaluated with angiography. All angiograms were analyzed with use of statistical software. Results: We constantly identified three vascular zones: (1) the medial vascular zone, which had the richest blood supply; (2) the lateral vascular zone, in which the density of vascularity was good and much better than that in the posterior zone; and (3) the posterior vascular zone, which showed the poorest blood supply. Conclusions: The richest vascular zones of the skin covering the Achilles tendon are located toward the medial and lateral aspects of the Achilles tendon. On the basis of the present study, we recommend using a medial or lateral incision in the integument covering the tendon, as the posterior incision will be located in a less vascular zone. Clinical Relevance: The present study should help the surgeon to plan the surgical approach to the Achilles tendon by designing skin incisions in a more vascular zone.