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