Anatomical study of the human sole of the foot by 4-dimensional CT angiographic vascular imaging – its suitability as composite tissue allotransplantation graft for foot defects

Abstract

The reconstruction of the weight-bearing sole is a challenge for every plastic surgeon. Composite tissue allotransplantation (CTA) of the sole of the foot may be a good therapeutic option for patients with large defects in the weight bearing area of the foot. As part of the preparation for a CTA of the sole, we sought to prepare for technical aspects related to preparation and perfusion of the human sole, on the basis of a systematic anatomical study, in combination with 4-dimensional computed tomography-angiography. An anatomical study was performed on 10 cadaver feet. CT images of the feet were prepared in a GE light speed 16-line computed tomogram (CT) before and after the preparation of the sole. After each CT scan, contrast medium was injected in 0.2 ml steps over the posterior tibial artery. Good images of the vessels of the sole from all 10 feet were achieved after recovery of the posterior tibial artery with accessory veins, the tibial nerve, the medial calcaneal branches from the posterior tibial artery, the abductor hallucis, digitorum brevis, abductor digiti minimi, lumbricales and interossea plantares muscles, even after preparation of the soles. With this systematic anatomical preparation of the soles of the feet from human cadaver preparations, in combination with 4-dimensional CT angiography, we were able to demonstrate the technical feasibility of sole transplantation. CT angiography should be performed preoperatively, in order to demonstrate that the vessels are patent as pedicle for the sole of the foot.