figure legend:
Three-dimensional reconstructed human ankle; cranial view. A - calcaneal tendon; Ca - calcaneus; F - deepfascia surrounding the tendons and neurovascular bundle; Fi - fibula; FD - flexor digitorum longus; Fc - deep fascia of the leg; FH - flexor hallucis longus; LTFA - anterior tibio-fibularligament; LTFP - posterior tibio-fibularligament; PTA - posterior tibial artery; Sk - skin; T - tibia; Ta - talus; TN - tibial nerve; TP - tibialisposterior.
scientific background:
This reconstruction was done for developing a computerized model of the human ankle using plastinated slices. This method could be applied to reconstruct any desired region of the human body. The aim was to evaluate the topography of the posteromedial neurovascular bundle of the ankle. The anatomic relationship of the posteriormedial neurovascular bundle at different levels of the ankle was studied as an aid in planning minimal invasive surgery of the ankle. A thorough knowledge of the local anatomy is a prerequisite prior to attempting release of the tibial nerve, or when using the posteromedial portal for ankle arthroscopy.
method: The ankle was frozen at -80°C for one week. Next, a tissue block containing the ankle was produced for plastination limited 40 mm distally to and 50 mm proximally to the tip of the lateral malleolus. The dehydrated/degreased specimen was submerged in the E12 impregnation mixture in a vacuum drying oven at +30°C. Pressure was continuously reduced, 80 mm Hg daily, starting at 400 mm Hg, over five days until 2 mm Hg was reached. After impregnation, the specimen was removed from the vacuum oven and placed in a mold. The mold was filled with the polymer-reaction mixture. The filled mold, containing the impregnated specimen, was placed in an oven at 65°C for 4 days to harden the polymer. Using a contact point diamond blade saw Exact 310 CP, the E12 block was cut into 1 mm slices. The ultra thin plastinated slices were scanned using an Image Scanner at 600 dpi. These images (jpeg) were loaded into WinSURF (SURFdriver 4.0). Each object was traced manually by using a graphic tablet and numbered accordingly. After that, the reconstruction was rendered, visualized, and qualitatively checked for surface discontinuities by rotating the model.
method: The ankle was frozen at -80°C for one week. Next, a tissue block containing the ankle was produced for plastination limited 40 mm distally to and 50 mm proximally to the tip of the lateral malleolus. The dehydrated/degreased specimen was submerged in the E12 impregnation mixture in a vacuum drying oven at +30°C. Pressure was continuously reduced, 80 mm Hg daily, starting at 400 mm Hg, over five days until 2 mm Hg was reached. After impregnation, the specimen was removed from the vacuum oven and placed in a mold. The mold was filled with the polymer-reaction mixture. The filled mold, containing the impregnated specimen, was placed in an oven at 65°C for 4 days to harden the polymer. Using a contact point diamond blade saw Exact 310 CP, the E12 block was cut into 1 mm slices. The ultra thin plastinated slices were scanned using an Image Scanner at 600 dpi. These images (jpeg) were loaded into WinSURF (SURFdriver 4.0). Each object was traced manually by using a graphic tablet and numbered accordingly. After that, the reconstruction was rendered, visualized, and qualitatively checked for surface discontinuities by rotating the model.