reply: about the arterial anatomy of the achilles tendon

Letter to the Editor

Reply: About the Arterial Anatomy of theAchilles Tendon

To the Editor, Clinical Anatomy:

We would like to thank Professor Matusz for his letterpertaining to our recently published study ‘‘The arterialanatomy of the Achilles tendon: Anatomical study and clini-cal implications’’ (Matusz, in press). In his letter, ProfessorMatusz kindly provides his own data to corroborate that ofour own, showing that it is indeed the midsection of theAchilles tendon that has the poorest vascularity and is thesite of greatest risk for devascularization and/or tendonrupture. Although our cohort comprised cadavers of agerange 60–85, it is certainly interesting to know that this rel-ative deficiency of the vascularity of the midsection of theAchilles tendon is present in all age ranges, as early as inthe fetal studies by Matusz. This demonstrates that it is nei-ther a degenerative vascular process nor a secondary effectfrom tendon degeneration, but rather this is part of theembryology of the Achilles tendon.

Professor Matusz also discusses the process of suralnerve harvest, a technique that does involve open incisionin the vicinity of the lateral margin of the Achilles tendon.In our manuscript, we were eager to highlight that it indeedis this lateral margin that is of importance in preserving theblood supply from the peroneal artery, its sole source inthis region. In commenting that all surgical approaches tothis region should avoid the lateral margin where possible,

we used Achilles tendon lengthening as a case example.However, there are numerous surgical interventions thatwarrant incisions in this region, and sural nerve harvest iscertainly one of these. Open reduction of fractures, fasciot-omies, and tendon transfers about the ankle are othersurgical procedures that necessitate care in avoiding theperoneal artery in this region.

Tony Chen, Warren M. Rozen,Wei-Ren Pan, Mark W. Ashton,

Martin D. Richardson,* and G. Ian TaylorJack Brockhoff ReconstructivePlastic Surgery Research Unit

Department of Anatomy and Cell BiologyThe University of MelbourneParkville, Victoria, Australia

REFERENCES

Matusz P. 2010. About the arterial anatomy of the achilles tendon(tendo calcaneus). Clin Anat 23:243–244.

*Correspondence to: Martin D Richardson, Jack Brockhoff Recon-structive Plastic Surgery Research Unit, Room E533, Departmentof Anatomy and Cell Biology, The University of Melbourne, GrattanSt, Parkville, Victoria 3050, Australia.E-mail: pdodwell@unimelb.edu.au

Received 4 November 2009; Accepted 6 November 2009

Published online 28 January 2010 in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ca.20917

VVC 2010 Wiley-Liss, Inc.

Clinical Anatomy 23:245 (2010)