The term angiosome describes all tissue contained within the surgical layers of dissection supplied by a single source artery. There are five angiosomes in the foot and ankle, and they are supplied by the posterior tibial, anterior tibial and peroneal arteries. One can determine angiosome patency in the presence of macrovascular occlusive disease in the area of infection via a complete physical examination with a handheld Doppler. This information is vital in terms of incision placement, systemic antibiotic tissue penetration and the overall healing potential of infected sites.17-19 Thorough knowledge of angiosome principles is strongly encouraged for any surgeon undertaking diabetic limb salvage.
Diabetic foot surgeons do not cure infection. Our ultimate goal is facilitating healing through our surgical intervention, treatment and education. This is a challenging field that is only going to get more difficult in the future. With so many variables against us, we need to take advantage of those factors that we have some control over.
Expert knowledge of lower extremity anatomy is one of those factors that can have a true positive impact on patient outcomes if one applies this knowledge appropriately during the preoperative planning. Ask yourself the three questions of “Where?” the next time you encounter a diabetic foot infection.
Dr. Meyr is affiliated with the INOVA Fairfax Hospital Podiatric Surgical Residency Program in Falls Church, Va.
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. He is a Fellow of the American College of Foot and Ankle Surgeons.