The safest surgical incisions and amputations applying the angiosome principles and using the Doppler to assess the arterial-arterial connections of the foot and ankle.

Abstract

Knowing the arterial anatomy of the foot and ankle in addition to understanding the angiosome concept provides the basis for careful and safe planning of incisions. The Doppler allows the surgeon to map out the actual vascular anatomy that exists preoperatively and therefore allows for appropriate adjustment to the planned incisions. If the vascular flow is inadequate for the planned surgery, then the vascular surgeon has to intervene to improve the existing blood flow. If the vascular tree is so compromised that successful revascularization of the affected angiosome is impossible, then the revascularization is likely to fail. Serious consideration to a below-knee amputation should then enter the decision tree at that time. Most of the time, however, the blood flow is adequate or can be sufficiently augmented with vascular surgery. The foot and ankle surgeon can then perform preoperative mapping of the arterial blood supply with the Doppler. By making the necessary adjustments to the planned incision, surgery can proceed safely with uneventful healing.