CORR Insights®: The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Ries, Michael D.

doi:10.1007/s11999-015-4277-y

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…Unfortunately, this literature fails to describe the subdermal vascular network in these areas, which is the anatomic layer of importance in wound healing. As has been previously reported in the general and orthopedic surgery literature, subdermal perfusion linearly correlates with tissue oxygen tension, collagen deposition, and subsequent healing (Schreml et al, ; Jonsson et al, ; Ries, ; Wyles et al, ). Consequently, it is important to characterize the subdermal perfusion of elbow integuments in order to understand its correlative importance to wound healing.…”

Section: Introductionsupporting

confidence: 55%

“…The data provided in this study characterizes the subdermal vascular network about the elbow, the predominant direction of perfusion, volume of circulation, and degree of anastomoses in the subdermal tissues. As has been previously established in the general and orthopedic surgery literature, subdermal perfusion linearly correlates with oxygen tension, collagen deposition, and subsequent wound healing (Schreml et al, ; Jonsson et al, ; Graham et al, ; Ries, ). The characterization of the subdermal vascular patterns about the posterior elbow offers insight into the cause of ischemic wound complications and the risk posed by surgical intervention in this area.…”

Section: Discussionmentioning

confidence: 63%

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A Cadaveric Study of Cutaneous Vascular Anatomy about the Elbow Using Computed Tomography Angiography

et al. 2019

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The posterior approach is a commonly employed exposure of the elbow that provides excellent visualization and efficacy for various orthopedic procedures, including total elbow arthroplasty (TEA) and fracture care. The posterior approach to the elbow has been associated with an increased rate of wound complications, including infection, skin necrosis, and wound dehiscence. Despite an association between these complications and decreased elbow perfusion, data regarding the intrinsic anatomic etiology for preferential complications in this area has been scarcely reported in the literature. This study characterizes the subdermal and cutaneous vascular perfusion about the elbow by describing the predominant direction of circulation, subdermal anastomoses, and volume of perfusion through cadaveric modeling using computed tomography angiography (CTA). Fifteen upper extremity cadaver specimens were prepared with injection of radiographic contrast directly into the axillary artery immediately preceding CTA imaging of each specimen. Sectra IDS7 software for Windows was used for analysis of all images to produce superimposed axial and 3-D reconstructions of each CTA series. From these images it was discerned that the predominant direction of flow in the posterior elbow integument is anterior medial to posterior lateral. Both the posterior medial and posterior lateral subdermal vascular networks emanate from proximally derived medial arterial sources with few anastomoses and minimal collateral perfusion from the anterolateral location. Consequently, it is important to preserve medial subdermal vascular structures to prevent ischemic wound complications. This is especially true in previously incised elbow integuments. Clin. Anat. 32:509-514, 2019.

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Section: Introductionsupporting

confidence: 55%