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Intraosseous and extraosseous blood supply to the medial cuneiform: implications for dorsal opening wedge plantarflexion osteotomy. Foot Ankle Int 2014 Apr;35(4):394-400

Date

01/01/2014

Pubmed ID

24375672

DOI

10.1177/1071100713518505

Scopus ID

2-s2.0-84899012263   10 Citations

Abstract

BACKGROUND: Osteotomies of the medial cuneiform are commonly used to correct forefoot deformity. Bone healing occurs despite periosteal stripping of the dorsal and medial surfaces of this widely articulated bone followed by osteotomy in the midsection of the bone. The objective of this study was to characterize the blood supply of the medial cuneiform.

METHODS: Thirty matched pairs of adult cadaver legs, 60 legs total, were amputated below the knee, and arterial casts were created with India ink and latex. Soft tissues were debrided, allowing visualization of the extraosseous blood vessels. In 53 specimens the vascular supply to the medial cuneiform was photographed and recorded. Forty-nine specimens were then cleared using a modified SpƤlteholz technique. The intraosseous vascularity of the medial cuneiform was successfully characterized and reviewed in 48 of these specimens.

RESULTS: The extraosseous blood supply was similar to previous reports with a middle pedicle branch originating from the dorsalis pedis artery. The medial plantar and superficial medial plantar artery supplied the plantar aspect of the bone. Intraosseous analysis showed a dense capillary network throughout the cuneiform, with typically one central medial major and several minor nutrient arteries noted. Areas of hypovascularity were infrequent and when noted occurred at inconsistent locations.

CONCLUSION: These findings support the clinical suspicion that the medial cuneiform is well vascularized from multiple sources. The plantar blood supply is likely sufficient to allow bone healing after dorsal periosteal exposure and possible injury to the middle pedicle branch of the distal medial tarsal artery.

CLINICAL RELEVANCE: A medial cuneiform opening wedge osteotomy can be used to correct forefoot deformity. This study investigates the blood supply to that bone to better characterize the healing potential of the medial cuneiform.

Author List

Kraus JC, McKeon KE, Johnson JE, McCormick JJ, Klein SE

Author

Jonathan C. Kraus MD Assistant Professor in the Orthopaedic Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Cadaver
Forefoot, Human
Humans
Osteotomy
Tarsal Bones