Tibia – Posterolateral Approach

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