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Indications
  • Provides safe exposure to
    • medial (subcutaneous) border of the tibia
    • lateral (extensor) surface of the tibia
    • preferred approach to tibia unless the skin is compromised
  • Indications
    • ORIF of tibia fractures
    • bone grafting for nonunion or delayed union
    • implantation of electrical stimulators
    • excision or biopsy of bone lesions
    • osteotomy
   
Internervous Plane
  • None
    • dissection carried epi-periosteal between tibialis anterior and tibia
   
Preparation
  • Anesthesia
    • general 
    • sciatic or saphenous nerve blocks
  • Position
    • supine
  • Tourniquet
    • exsanguinate limb
 
Approach 
  • Incision
    • make a longitudinal incision 1 cm lateral to the anterior border of tibia 
    • length of incision depends on procedure, but the tibia may be exposed along its entire length
  • Superficial dissection
    • elevate skin flaps to expose the medial (subcutaneous) border of the tibia
    • be sure to protect the long saphenous vein when retracting the skin flaps
  • Deep dissection 
    • medial subcutaneous surface
      • essential to minimize subperiosteal stripping
      • incise periosteum longitudinally along the middle of the medial border
      • reflect the periosteum anteriorly and posteriorly
    • lateral extensor surface
      • incise periosteum over anterior border of the tibia
      • subperiostally dissect the tibialis anterior and neurovascular bundle and retract laterally
 

 
    Clinical Images
           
     
Structures at Risk 
  • Long Saphenous Vein
    • is on medial side of calf and should be protected when raising  a medial skin flap
   
     
 

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