Knee – posterior approach

* position – supine & tourniquet

* incision
– start lat. over BF & bring incision obliquely across popliteal fossa
– turn down over med. head of gastroc.

* no internervous plane

* dissection
– reflect skin flaps
– expose lesser saphenous v.
– running lat. to vein is med. sural n. (branch of tibial n.)
– incise fascia of popliteal fossa just med. to lesser saphenous v.
– trace med. sural n. back to tibial n.
– dissect up to apex of popliteal fossa following tibial n.
– at apex, CPN separates from tibial n.
– ID popliteal art. & vein
– art. has 5 branches — 2 superior, 2 inferior & 1 middle genicular art.
– vein lies med. to art. as it enters popliteal fossa from below
– curves lying directly post. while in fossa
– moves to posterolat. side of art. above knee joint

> posteromed. joint capsule
– detach origin of med. head of gastroc. from back of femur
– retract head lat. & inf.
– expose posteromed. joint

> posterolat. corner
– detach origin of lat. head of gastroc. from lat. fem. condyle
– develop interval btw gastroc. & BF
– incise joint capsule

* dangers
– med. sural n. – lies lat. to lesser saphenous v. so incise fascia med. to vein
– tibial n.
– popliteal vessels

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