Posterolateral Approach to Tibia

Indications

• middle 2/3 of tibia when skin is badly affected & anterior app cannot be sed

Principles

• Posterior to Fibula, reflecting FHL
• Along interosseus membrance
  • Reflecting tibialis posterior

Position

• Lateral
• Protect bony surfaces

Landmarks

• Lateral border of gastrocnemius

Incision

• Straight longitudinal incision over lateral border of gastrocnemius muscle

Internervous Plane

• Gastrocnemius, solues, FHL
  • Tibial nerve
• Peroneal muscles
  • Superficial peroneal nerve

Superficial Dissection

• Reflect skin flaps
• Taking care not to damage
  • Short saphenous vein
• Incise fascia
• Develop the plane between:
  • lateral head of gastrocnemius & soleus posteriorly
  • peroneal muscles anteriorly
• Encountered
  • Muscular branches of peroneal artery lie with peroneus brevis in proximal part & may be ligated

Deep Dissection

• Reflect FHL off the posterior aspect of fibula & retract it posteriorly
• Continue dissection medially across the interosseus membrane detaching fibres of tibialis posterior
• This leads to lateral border of tibia

Dangers

• Nerves
• Vessels
  • Short saphenous vein
  • Branches of peroneal artery
  • Posterior tibial artery