Updated: 3/26/2013

Tarsus and Ankle Kocher (Lateral) Approach

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Indications
  • Excellent exposure to
    • ankle joint
    • midtarsal joint
    • subtalar joint
  • Disadvantage include
    • danger of skin sloughing
    • peroneal tendons usually need to be divided and repaired
 
Approach
  • Position
    • supine with bump under buttock
    • partial exsanguination (allows better visualization of neurovascular bundle)
  • Incision
    • begin just lateral to distal head of talus
    • curve posteriorly to point 2.5 cm below tip of lateral malleolus
    • curve proximally and run parallel to fibula and 2.5 cm posterior to it
    • end 5-10 cm proximal to the lateral malleolus
  • Superficial dissection
    • incise fascia down to peroneal tendons and retract them posteriorly
      • may divide peroneal tendons with Z-plasty for larger operative field and repair at end of case
    • Avoid lesser saphenous vein and sural nerve which lay posterior to incision
  • Deep dissection
    • Divide calcaneofibular ligament and expose subtalar joint
    • If desired may expose calcaneocuboid joint through distal end of incision
    • If desired may divide talofibular ligaments and dislocate talus by medial traction to expose articular surface of the tibia
Dangers
  • Lesser saphenous vein
  • Sural nerve
 

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