Angiosomes of the Foot and Ankle and Clinical Implications for Limb Salvage: Reconstruction, Incisions, and Revascularization

Attinger, Christopher E.; Evans, Karen K.; Bulan, Erwin J.; Blume, Peter; Cooper, Paul S.

doi:10.1097/01.prs.0000222582.84385.54

Cited by 488 publications

(499 citation statements)

References 33 publications

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“…The thermogram, numbered 1037, in Figure 4, does not show a smooth temperature distribution, that is, there are hot spots within a region where slight temperature changes are expected (for the corresponding angiosomes [16]). This type of abrupt temperature changes had been associated to inflammatory regions [14,17], with the condition that the contralateral region is 2.2°C colder (this condition has been questioned its validity [18]).…”

Section: Discussionmentioning

confidence: 99%

The abrupt temperature changes in the plantar skin thermogram of the diabetic patient: looking in to prevent the insidious ulcers

Renero-Carrillo

2018

Diabetic Foot & Ankle

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Background: One of the complications of the diabetes mellitus is the amputation of the lower limbs. This complication may be developed after an insidious ulcer, that may be raised by the peripheral neuropathy or the ischaemic limb, and that the ulcer get infected. That is, to develop an ulcer, in the diabetic patient, three factors should be taken into the account, the autonomic nervous system, the blood supply and the inmune system. Methods: In this work, the thermogram is used to identify regions on the plantar skin with blood supply deficiencies and the behaviour of the thermoregulation process. Within the thermogram of the plantar skin, it can be identify local regions with low and high temperatures that corresponds to ischemic or inflammatory process on that part of the skin. Results: The findings within the 186 thermograms of diabetic patients, obtained from three hospitals and from INAOE facilities, showed, first, the thermograms of the plantar skin of two diabetic patients, acquired in two different times show that the temperature distribution and the average temperatures, vary slightly for a period of weeks. Second, the thermograms of two patients, who both developed insidious ulcers which evolved favourable, demonstrated the importance of the immune system and the drug therapy. These patients are, one who has a Charcot foot, and in the second one, the patient had loss the sensibility of the feet. Finally, the thermograms of two patients, showing abrupt temperature change within small regions in the plantar skin, are discussed. Conclusion: A diabetic patient, with an asymmetric thermogram, as physiological interpretation of the thermoregulation, may indicate a decrease of the blood supply, which may be corroborated by vascular ultrasound. The regions of abrupt temperature change, cold or hot spots, may correspond to ischaemic or inflammatory processes.

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Section: Discussionmentioning

confidence: 99%

The abrupt temperature changes in the plantar skin thermogram of the diabetic patient: looking in to prevent the insidious ulcers

Renero-Carrillo

2018

Diabetic Foot & Ankle

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“…In recent years, on the basis of anatomical studies by Taylor and Pan [35] and Attinger et al [36], the angiosome model was developed. Angiosomes are the areas in which the human body is divided according to arterial and venous distributions.…”

Section: Discussionmentioning

confidence: 99%

“…Angiosomes are the areas in which the human body is divided according to arterial and venous distributions. The foot is divided into five angiosomes: the medial calcaneal; the medial plantar; the lateral plantar, which arises from the posterior tibial artery; the dorsal foot angiosome, which arises from the anterior tibial artery; and finally the lateral calcaneal angiosome, which derives from the peroneal artery [35,36]. The angiosome model was then introduced into clinical practice to test its effectiveness in terms of limb salvage.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

Fossaceca

Guzzardi

Cerini

et al. 2013

Cardiovasc Intervent Radiol

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Purpose To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in a selected population of diabetic patients with below-the-knee (BTK) disease and to analyze the reliability of the angiosome model. Methods We made a retrospective analysis of the results of PTA performed in 201 diabetic patients with BTK-only disease treated at our institute from January 2005 to December 2011. We evaluated the postoperative technical success, and at 1, 6, and 12 months' follow-up, we assessed the rates and values of partial and complete ulcer healing, restenosis, major and minor amputation, limb salvage, and percutaneous oximetry (TcPO 2 ) (Student's t test). We used the angiosome model to compare different clinicolaboratory outcomes in patients treated by direct revascularization (DR) from patients treated with indirect revascularization (IR) technique by Student's t test and the v 2 test. Results At a mean ± standard deviation follow-up of 17.5 ± 12 months, we observed a mortality rate of 3.5 %, a major amputation rate of 9.4 %, and a limb salvage rate of 87 % with a statistically significant increase of TcPO 2 values at follow-up compared to baseline (p \ 0.05). In 34 patients, treatment was performed with the IR technique and in 167 by DR; in both groups, there was a statistically significant increase of TcPO 2 values at follow-up compared to baseline (p \ 0.05), without statistically significant differences in therapeutic efficacy. Conclusion PTA of the BTK-only disease is a safe and effective option. The DR technique is the first treatment option; we believe, however, that IR is similarly effective, with good results over time.

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“…This cooperation allowed to design the road map for diagnosis of CLI and the best endovascular approach. Particularly, it is currently stronger the concept of "wound related artery", defined as the target revascularization addressed to the artery that perfuses the wound area [57,58]. Moreover, the treatment of the angiosome involved by the lesion seems to show best results in terms of limb salvage and wound healing if compared to not target revascularization [59,60].…”

Section: Clinical Reseaerch On Foot and Anklementioning

confidence: 99%

Limb Salvage in Diabetic Patients: The Italian Experience

Meloni¹

2014

Clin Res Foot Ankle

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Diabetes is rapidly increasing worldwide and diabetic foot is the main cause of non-traumatic lower limbs amputation. However epidemiological data report a reduction of amputee's rate in different European countries and in USA. Also in Italy there were excellent results related to the improvement of treatment strategies. The aim of this commentary is to describe the Italian model analyzing the reasons that have contributed to this success.

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Angiosomes of the Foot and Ankle and Clinical Implications for Limb Salvage: Reconstruction, Incisions, and Revascularization

Cited by 488 publications

References 33 publications

The abrupt temperature changes in the plantar skin thermogram of the diabetic patient: looking in to prevent the insidious ulcers

The abrupt temperature changes in the plantar skin thermogram of the diabetic patient: looking in to prevent the insidious ulcers

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

Limb Salvage in Diabetic Patients: The Italian Experience

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