OrthoNet

Tibia - posterolateral approach

* used to expose middle 2/3 of tibia when skin over subcut. surface is badly scarred or infected

* position - 45deg. of lat. decubitus position with affected leg up with tourniquet

* internervous plane - gastroc/soleus/FHL (tibial n.) & peroneal muscles (SPN)

* dissection
- reflect skin flaps taking care with lesser saphenous vein
- incise fascia in line with incision
- find plane btw lat. head of gastroc/soleus post. & PB/PL ant.
- muscular branches of peroneal art. lie with PB in prox. part of incision
- find lat. border of soleus & retract med. & post.
- ID FHL below arising from post. surface of fibula
- detach lower part of origin of soleus from fibula & retract med. & post.
- detach FHL from origin on fibula
- dissect med. across interosseous membrane detaching fibers of TP that arise from it
- follow interosseous membrane to lat. border of tibia
- expose post. surface of tibia subperiosteally

* dangers
- lesser saphenous vein - may be damage when skin flaps are mobilized
- peroneal art. - branches cross btw gastroc & PB muscles
- PTA & tibial n. - lay post. to FHL & TP