Surgical Approaches (Dr. J. Al

Report
Jamal Al-Asiri

Fore foot:
 Medial approach to MT1
 Dorsal approach to MT1
 Dorsal intermetatarsal approach

Mid foot:
 Dorsal double parallel incisions
Foot: 1st MTP Joint (Dorsomedial & Dorsal)

Indications
 Bunionectomy, DSTP,
Osteotomies, Arthroplasty, Fusion

Position
 Supine + Tourniquet

Landmarks/Incision
 MT Head + EHL
 Dorsomedial
▪ Direct medial over MTP joint
▪ Medial to EHL
▪ Plantar to dorsal digital nerve
▪ Parallel to Phalanx distal and MT
shaft proximal
 Dorsal
▪ Medial to EHL
▪ Directly over MTP joint
▪ Inline with the phalanx + shaft

Plane
 None
Foot: 1st MTP Joint (Dorsal & Dorsomedial)
Foot: 1st MTP Joint (Dorsal & Dorsomedial)

Superficial
 Dorsomedial
▪ Incise deep fascia inline
▪ Directly down to MTP joint
▪ Retract EHL + Dorsal Digital nerve
 Dorsal
 Incise deep fascia inline
 Retract EHL Lateral
 Directly down to MTP joint

Deep
 Reflect periosteum off phalanx + MT

Dangers
 EHL
 Dorsal digital nerve
 FHL (too much phalanx stripping
plantar side)
 Deep Peroneal Nerve (1st webspace)
Dorsal double parallel incisions
Positioning
 supine, with a bump under the affected hip.
Incisions:
•The first incision is longitudinal, in the space between first
and second MTs or over the second MT.
•It is approximately 5 cm in length, lateral to the extensor
hallucis longus (EHL), with the distal end of the incision 3
cm distal to the first TMT joint.
•The superficial sensory branches of the superficial
peroneal nerve are isolated and preserved.
•The inferior extensor retinaculum is excised, and the
neurovascular bundle found between the EHL and EHB is
isolated. The EHL is retracted medially to visualize the
Lisfranc joint.
•If the third TMT joint is still unstable, a second longitudinal
incision is created over the third-fourth MT space or over the
fourth MT.
•The lateral superficial sensory branches of the
superficial peroneal nerve are protected.
•The (EDL) is elevated to expose the (EDB), which can be
split longitudinally or elevated from lateral to medial.

Hind foot (Talus):
 Anterolateral to the talus
 Anteromedial to the talus
 Posteromedial to the talus
 Posterolateral to the hindfoot
Anteromedial Approach to the Talus
Postion:
 Supine
Incision:
 10cm longitudinal curved incision
on the medial aspect of the ankle
just anterior to the tip of the
medial mal
Interval:
 Between Tib ant& Tib post
Dangers:
 Saphenous nerve and long
saphenous vein
Anterolateral Approach to the Talus
 Postion:
 Supine with sandbag under the hip
 Incision:
 10 cm slightly curved incision on
the anterolateral aspect of the
ankle 2cm anterior to the anterior
border of the fibula, toward the
base of the 4th metatarsal
Interval:
 Peroneal muscles (superficial
peroneal nerve) and extensor
muscles (deep peroneal nerve);
Detach and reflect the extensor
digitorum brevis from it origin on
the calcaneus
Dangers:
 Dorsal cutaneous branches of
superficial peroneal n.; Deep
peroneal n. & dorsalis pedis art
Posteromedial approach to the talus
Anatomy
This rarely-used approach is extremely useful
and follows the plane between flexor hallucis
longus and the Achilles tendon. The
neurovascular structures lie posteromedially
behind the medial malleolus and must be
protected
Incision
Skin incision
Using the Achilles as the lateral boundary, and
the neurovascular structures posteromedially,
a skin incision is made centered over the
subtalar joint using image intensification.
Posteromedial approach to the talus
Superficial dissection
The structures that run behind the medial
malleolus are very important here. The most
posterior structure, flexor hallucis longus, is
identified so the surgeon can go posterior and
lateral to it and medial to the Achilles tendon.
Deep dissection
The tendon sheath of the flexor hallucis
longus must be opened. This allows the
retraction of the tendon together with the
neurovascular bundle and gains exposure of
the fracture.
Lateral to the tendon sheath of the FHL is the
posterior tubercle of the talus.
The surgeon must be careful not to be too
proximal and mistake the distal tibia for the
talus. Fixation and debridement can now be
completed.
Posterolateral approach to the talus
Incision
This approach is very useful as it is a true
internervous and intermuscular approach
which is very safe. It is useful as an approach
to the posterior talus, the posterior aspect of
the distal tibia, the posterior distal fibula and
the posterior portion of the calcaneus.
The skin incision is made vertically between
the peroneal tendons anteriorly and the
Achilles tendon posteriorly.
In the depth one encounters the sural nerve
which must be protected together with its
lateral calcaneal branch, which - if cut - results
in a painful neuroma. Deeper and medially one
encounters the belly of the flexor hallucis
longus. For an approach to the talus and the
subtalar joint and the Volkmann’s triangle the
flexor hallucis longus must be retracted
medially.

Hind foot (Calcaneus):
 Extended lateral approach to calcaneus
 Medial approach to the calcaneus
Extended lateral approach to calcaneus
Anatomy
Vascular supply
The perforating branches of the peroneal
artery contribute to the vascularity of the
lateral skin and soft tissue of the foot. The
undermining of skin edges runs the risk of skin
edge necrosis and therefore full-thickness
flaps have to be developed to prevent this
complication.
The lateral calcaneal artery is responsible for
the majority of the blood supply to the corner
of the L-shaped flap of this approach.
The heel pad is mostly supplied from the
posterior tibial artery branches medially.
The sural nerve needs to be protected in the
horizontal part of the approach.
Extended lateral approach to calcaneus
Incision
Skin incision
The posterior arm of the incision is placed
midway between the fibula and Achilles
tendon. The horizontal arm is placed in line
with the base of the fifth metatarsal.
They meet at a corner where skin handling
must be optimized.
Development of flap
The undermining of the edges must be
avoided. One creates a full-thickness flap and,
as the flap is developed, one divides the
retinaculum and detaches the CFL and
talocalcaneal ligaments from bone. The
peroneal tendons and the sural nerve are
within the flap and are not exposed. As the
flap is developed upwards, one exposes the
subtalar joint and the sinus tarsi.
Extended lateral approach to calcaneus
Incision
Skin incision
The posterior arm of the incision is placed
midway between the fibula and Achilles
tendon. The horizontal arm is placed in line
with the base of the fifth metatarsal.
They meet at a corner where skin handling
must be optimized.
Development of flap
The undermining of the edges must be
avoided. One creates a full-thickness flap and,
as the flap is developed, one divides the
retinaculum and detaches the CFL and
talocalcaneal ligaments from bone. The
peroneal tendons and the sural nerve are
within the flap and are not exposed. As the
flap is developed upwards, one exposes the
subtalar joint and the sinus tarsi.
Medial approach to calcaneus
Incision
Skin incision
The center of the incision is 2 cm beneath the
medial malleolus and 2 cm proximal to the
navicular.
To achieve adequate visualization of the
sustentaculum, it needs to be about 5 cm in
length, following the neurovascular structures.
Superficial dissection
Once beneath skin, identify the posterior tibial
tendon, the neurovascular bundle and the
flexor hallucis tendon. The interval to develop
is between the neurovascular bundle,
specifically the posterior tibial nerve and the
flexor hallucis tendon, which is retracted
distally.
Medial approach to calcaneus
Deep dissection
The sustentaculum is a bony prominence
which is obvious once one is beneath the
medial neurovascular structures. Usually,
fixation is placed into the calcaneus
immediately below the sustentaculum, which
has been fractured and displaced
plantarwards.
Image intensification will verify the surgeon’s
position in this deep approach.
The small bony fragment mandates use of
mini fragment fixation.





Lateral approach
Medial approach
Posterolateral approach**
Posteromedial approach
Anterior approach
Lateral approach
Incision
If a lateral plate is required for the lateral
malleolus, the incision should be placed either
slightly anteriorly or posteriorly, so that the
plate does not come to lie directly beneath the
incision.
If a posterior plate is planned, place the
incision slightly posteriorly, so that the softtissue dissection can be minimized.
Proximal extension
In case a distal fracture extends proximally, the
incision can be extended proximally.
The plane of dissection is the same, but
particular care must be taken with the
superficial peroneal nerve. In this case it is
advisable to identify and protect the nerve.
Lateral approach
Superficial surgical dissection
The dissection plane is between the peroneus
tertius anteriorly and the peroneus longus and
brevis posteriorly. The figure shows a long
incision, such as would be used for
suprasyndesmotic fractures.
Handling the damaged soft tissue is crucial.
Use small retractors only in good soft-tissue
conditions. Retracting with protecting sutures
is a safe method.
Note
Be careful not to damage the superficial
peroneal nerve, which lies very closely
anteriorly, especially in the proximal part of the
incision. In more anterior incisions, it should be
identified and protected. When dissecting
posteriorly, be careful not to damage the short
saphenous vein and the sural nerve.
Lateral approach
Deep surgical dissection
Free the periosteum at the fracture site. In
order to minimize devascularization, reflect
only as much of the periosteum as is needed
to expose the fracture site. Unnecessary
stripping of the periosteum reduces the blood
supply of the bone.
If it is necessary to extend the dissection, keep
it close to the periosteum, in order to avoid
damage to terminal branches of the peroneal
artery.
The fracture site is now exposed and should be
cleaned before it is reduced.
Medial approach
Incision
Start the incision 2 cm distal to the anterior tip
of the medial malleolus. Curve the incision
towards the anterior edge of the medial
malleolus and in the direction of the middle of
the distal tibia.
Find the saphenous vein and nerve, and use a
vessel loop to retract them.
Surgical dissection
Expose the anterior part of the fracture site,
free the periosteum from the edges of the
medial malleolus to the distal tibial joint
surface and inspect the joint.
If necessary, make a vertical incision at the
anteromedial edge of the joint capsule.
Dissect the capsule as far as necessary to
visualize the fracture and the joint surfaces.
Remove the periosteum posteriorly only
sufficiently to control reduction.
Posteromedial approach
Incision
This approach is indicated in cases of posterior
comminution and/or a posterior extension of a
medial malleolar fracture.
Start the incision 1 cm distal and 1 cm anterior
to the middle of the tip of the medial
malleolus. Curve the incision dorsally over the
tip of the medial malleolus and in the direction
of the posterior crest of the distal tibia.
Note
Be careful not to damage the saphenous vein
and nerve, especially distally.
Superficial surgical dissection
Deepen the approach through the
subcutaneous fat and the fascia, in a direct
line with the posteromedial crest of the tibia.
Deepen the dissection of the fracture site
without stripping off the periosteum.
Posteromedial approach
Deep surgical dissection
Follow the fracture line to the posterior edge
of the distal tibia. Open the crural fascia at the
edge of the posterior tibia, proximally as far as
necessary, and distally as far as the proximal
insertion of the flexor retinaculum.
Retract the tendons of the tibialis posterior
muscle and the flexor digitorum longus muscle
and the posterior tibial neurovascular bundle,
using blunt retractors.
Develop the dissection until the fracture line
at the posterior part of the tibia is entirely in
view.
Dissect the periosteum only as far as required
for the control of the reduction at the
metaphysis. If necessary, follow the fracture
line anteriorly. Protect the saphenous nerve
and vein.

Distal Tibia:
 Anteromedial approach
 Anterolateral approach
 Posteromedial approach
 Posterolateral approach
Anteromedial approach
Skin incision
The incision for the anteromedial approach starts
about 5–8 cm proximal to the ankle joint, lateral to the
tibial crest. It runs in a straight line over the ankle joint
towards the base of the navicular, following the medial
border of the anterior tibial tendon. A straight incision
provides a better approach to the anterior part of the
tibia than a curved incision.
Anteromedial approach
Surgical dissection
Deepen the dissection to the periosteum
along the medial border of the anterior tibial
tendon, leaving the tendon sheath intact.
Minimal exposure and careful handling of the
periosteum are essential to prevent any
further vascular damage of the fracture
fragments.
The tibiotalar joint is opened in the sagittal
direction, usually in line with the fracture line
between the two main anterior articular
fragments.
Any transverse incision of the anterior capsule
to further expose the joint should be kept
short as this risks devascularization of the
anterior fragments (supplied by branches of
the anterior tibial artery).
Anterolateral approach
Skin incision
This incision is centered at the ankle joint,
parallel to the fourth metatarsal distally, and
parallel to and between the tibia and fibula
proximally. Dissection through the skin and
subcutaneous tissues should proceed sharply
with maintenance of full thickness skin flaps.
Since the anterior compartment muscles arise
from the anterior fibula, the incision is usually
not extended more than seven centimeters
above the ankle joint. Distally, the incision can
extend as far as the talonavicular joint.
SPN
Take care not to damage the superficial
peroneal nerve which lies directly beneath the
skin. This nerve invariably crosses the surgical
incision proximal to the ankle joint. It should
be identified, mobilized, and protected
throughout the surgical procedure.
Anterolateral approach
Surgical dissection
Distally, the extensor retinaculum is incised
and the anterior compartment tendons are all
retracted medially. Proximally, the entire
anterior compartment musculature, including
the peroneus tertius, can then be mobilized
and retracted medially.
The fascia of the extensor digitorum brevis
can be incised, with the muscle carefully
dissected and retracted medially. This allows
exposure of the talar neck for pin placement
and distractor application. Proper location of
the arthrotomy, preplanned to lie over the
fracture, is critical to avoid unnecessary and
damaging devascularization of fracture
fragments. Proximally, the dissection is
limited by the origin of the anterior
compartment muscles from the fibula and
from the interosseous membrane.
Posteromedial approach
Incision
The incision is centered at the ankle joint,
between the Achilles tendon and the
posteromedial border of the distal tibia.
Proximally the incision parallels the
posteromedial border of the tibia. Distally the
incision parallels the path of the posterior
tibial tendon.
Superficial surgical dissection
Deepen the incision through the
subcutaneous fat and fascia and reveal the
deep fascia over the tendons of tibialis
posterior and flexor digitorum longus, the
posterior tibial neurovascular bundle and the
flexor hallucis longus tendon.
For access to the posteromedial quadrant of
the distal tibia, it is necessary to carefully
incise the deep fascia proximally, protecting
the neurovascular bundle.
Posteromedial approach
Deep dissection
The interval used for deep dissection is dependent on the location of the major
fracture fragments.
1) It may be between the tibia and the posterior tibial tendon. This is useful for
proximal exposure only as the distal posterior tibial tendon should not be dissected
from the posterior tibia.
(2)
(3)
2) It may also be between the posterior tibial
tendon and the flexor digitorum communis
(see illustration).
3) Or it may be between the flexor digitorum
comminus and the flexor hallucis longus.
The latter of these three intervals requires
direct exposure and protection of the
neurovascular bundle along its length. The
neurovascular bundle can be retracted
anteromedially or posterolaterally.
Posterolateral approach
Posterolateral approach
Skin incision
Skin incision is made along the posteromedial
border of the fibula and can extend from the
tip of the fibula as far proximally as is required.
It should never be more medial than the
lateral border of the Achilles tendon.
Protect the sural nerve
It is important to be aware of the course of
the sural nerve as it courses from the center of
the calf proximally to just posterior to the
fibula distally.
Identify the sural nerve under the superficial
fascial layer and usually include it in the lateral
flap. If the dissection is extended more
proximally, it may be necessary to work on
either side of this nerve.
Posterolateral approach
Exposure of the fibula
Superficial surgical dissection to the fibula
If the fibula requires fixation, this option is
chosen. Maintain full thickness superficial
flaps to reduce the risk of skin necrosis.
Superficial dissection should be taken down
to the attachment of the peroneal fascia on
the posterolateral border of the fibula. Incise
the fascia, and retract the peroneals medially.
Posterolateral approach
Approach to the tibia
Surgical dissection to the tibia
Access to the tibia is through a separate plane
which is developed on the posteromedial
border of the peroneal muscles. These are now
retracted laterally.
Exposure of the posterior aspect of the tibia is
achieved by developing the interval between
the peroneal tendons and muscles laterally
and the flexor hallucis longus (FHL) medially.
Posterolateral approach
Deep surgical dissection to the tibia
FHL is recognizable from the very distal extent
of its muscle belly. It can also be identified by
moving the great toe. With sharp dissection of
the FHL along its lateral border, the entire
posterior aspect of the tibial surface can be
exposed by retracting this muscle medially.
This also provides protection of the
posteromedial neurovascular bundle.
Tibia: Exposure of the joint surface
Visualization of the articular surface or small
fragments preventing reduction of the
articular pieces can be difficult.
The posterolateral fragment is rotated
laterally around the usually intact posterior
tibiofibular ligament. The interval between
the boney fragments is developed giving
access to the center of the fracture.
Anterior approach

Tibia shaft:
 Anteromedial approach
 Anterolateral approach
 Posteromedial approach
 Posterolateral approach
Anteromedial approach
Anteromedial approach
Skin incision
Approach the anteromedial surface through a
longitudinal incision 1-2 cm lateral to the tibial
crest. Distally, continue along the medial edge
of the tibialis anterior in a gentle curve in the
direction of the medial malleolus.
The deep dissection should stay superficial to
the fascia layer of the anterior compartment.
The length of the incision depends on the
planned plate length.
Take care not to compromise the saphenous
vein and nerve, which are at risk at the distal
extend of the approach.
Entrance into the anterior tibial tendon sheath
should be avoided, as this can cause unwanted
adhesions.
Anteromedial approach
Dissection
Full thickness skin and subcutaneous tissue
flaps are then mobilized in a medial direction.
In this way the anteromedial aspect of the
tibia is directly exposed. The periosteum is left
intact, or minimally reflected from the fracture
edges, if necessary for a direct anatomical
reduction.
Anterolateral approach
Skin incision
A longitudinal incision lies 1-2 cm lateral to the
tibial crest and continues distally straight over
the ankle joint along the line of the anterior
tibial tendon.
The length of the incision depends on the
plate length.
The distal extension of the anterolateral
approach is helpful for distal tibial fractures,
but is obstructed by muscles and
neurovascular structures of the anterior
compartment.
Anterolateral approach
Dissection
The fascia is incised just lateral to the tibial
crest and the dissection is carried down
extraperiostally along the lateral surface of
the tibia.
The periosteum is left intact, though it may
require mobilization near the fracture site for
exposure of fracture edges. This is commonly
done in preparation for direct anatomical
reduction.
Anterolateral approach
Retraction of the tibialis anterior muscle
should be limited, to show only the essential
part of the anterolateral surface of the tibia.
Near the junction of the middle and lower
thirds of the tibia, the anterior compartment
vessels (Anterior Tibial) and nerve (Deep
Peroneal) come together and approach the
lateral tibial surface. They wrap obliquely
anteriorly and distally around the tibia. In the
distal metaphyseal area, they lie on the
periosteum, under the myotendinous portion
of tibialis anterior, extensor hallucis longus,
and extensor digitorum longus. If this
exposure extends into the distal third of the
tibia, the surgeon should identify and protect
the neurovascular bundle. With care, it can be
mobilized from the tibial surface, along with
the anterior compartment muscles. This
makes it possible to pass a plate more distally
on the anterolateral surface, all the way to the
ankle joint, if necessary.
Posteromedial approach
Skin incision
The length of the incision varies according to
fracture location and selected plate. The
posteromedial boarder of the tibia is first
palpated throughout its length. The incision is
then made in parallel 1-2 cm posterior to the
posterior tibial boarder.
Dissection
Subcutaneous dissection follows carefully so
as to identify and/or protect the saphenous
vein and nerve. These are typically mobilized
anteriorly.
Posteromedial approach
The fascia is then incised in line with the skin
incision and the superficial and deep posterior
compartments are mobilized. Gastrocnemius,
soleus and flexor digitorum will be identified
and mobilized with a soft-tissue elevator,
depending on the level of the fracture.
The dissection should be done in an extraperiosteal plane.
Dissection is not necessary beyond the
posterolateral aspect of the tibia.
In this way, the middle 3/5 of the posterior
tibia can be effectively exposed.
Posterolateral approach
Skin incision
The length of the incision varies, but it should
begin over the lateral boarder of the
gastrocnemius muscles and extend distally to
a point that is midway between the achilles
tendon and the fibula.
The interval between the lateral and posterior
compartments is usually easier to find distally.
Further dissection proximally is undertaken as
required.
Posterolateral approach
Dissection
The plane of the dissection will be between
the superficial posterior and lateral
compartments. The fascia is incised and the
gastrocnemius and soleus are mobilized
medially leaving the peroneal muscles
laterally. In this way, the posterolateral aspect
of the fibula is exposed.
Often there are crossing perforating branches
of the peroneal vessels, which must be ligated.
Posterolateral approach
Arising from the posterior aspect of the fibula
is the Flexor hallucis longus (FHL), which is
mobilized posteromedially. Medial dissection
is continued until the interosseus membrane is
encountered.
Note
One should proceed with caution when
mobilizing the deep posterior compartment. It
is crucial that the entire compartment is
mobilized from the fibula, interosseous
membrane and tibia.
Beginning outside the fracture zone, expose
the posterior and medial surfaces of the fibula,
and follow these to the interosseous
membrane. Retract the deep posterior
compartment contents from lateral to medial,
to protect the neurovascular structures.
Posterolateral approach
With the interosseous membrane identified,
mobilize the remainder of the deep posterior
compartment medialwards until the posterior
aspect of the tibia is encountered. Extend the
exposure proximally beyond the fracture as far
as necessary for plate fixation.
Be aware of the common peroneal nerve
crossing the fibular neck very proximally.
At the conclusion of the dissection the
surgeon should have access to the posterior
aspects of both the tibia and the fibula.

Proximal Tibia:
 Anterolateral approach
 Posteromedial approach
Anterolateral approach
Skin incision
Make a straight incision lateral to the patella.
Opening the fascia
Open the deep fascia anterior to the ilio-tibial
tract.
Anterolateral approach
Anterolateral approach
Release the proximal attachment of the
tibialis anterior muscle. If necessary release
the ilio-tibial tract by incising it or taking a
small flake of bone from Gerdy’s tubercle.
Avoid the peroneal nerve which runs posterior
to the biceps femoris tendon at its attachment
to the fibular head.
Caution
Do not attempt to expose the postero-medial
side of the tibia from the antero-lateral
approach.
Opening the joint
To expose the joint make a horizontal
capsulotomy between the the deep edge of
the meniscus and the tibia. At the time of
closure re-attachment of the meniscus and
capsule is mandatory.
Posteromedial approach
Skin incision
With the knee in slight flexion make a straight
or slightly curved incision running from the
medial epicondyle towards the postero-medial
edge of the tibia. The incision can be extended
as needed both proximally and distally as
indicated by the dashed line.
Deep dissection
After opening of the fascia identity and
expose the pes anserinus.
Posteromedial approach
Deep dissection
After opening of the fascia identity and
expose the pes anserinus.
Opening of the knee joint
Identify the meniscus and incise the capsule
between the meniscus and the edge of the
tibial plateau thus gaining access to the knee
joint.


Double-incision, 4-compartment dermatofasciotomy
Single-incision, parafibular 4-compartment
dermato-fasciotomy
Double-incision fasciotomy
Technique
Posteromedial Incision
The two posterior compartments are
approached through a single longitudinal
incision in the lower leg, two centimeters
behind the palpable posteromedial edge of
the tibia.
After reaching the fascia, undermine
anteriorly to the posterior tibial margin, in
order to avoid the saphenous vein and nerve.
The deep posterior compartment here is
superficial and readily accessible.
The fascia of the deep posterior compartment
is carefully opened distally and proximally,
under the belly of the soleus muscle, paying
special attention to the posterior tibial
neurovascular bundle.
Double-incision fasciotomy
Through the same incision, the fascia of the
superficial posterior compartment is opened
widely, two centimeters posterior and parallel
to the incision in the fascia of the deep
compartment.
Double-incision fasciotomy
Technique
Anterolateral incision
The anterior and lateral compartments are
approached through a single longitudinal
incision on the outer aspect of the leg, two
centimeters anterior to the fibular shaft and
long enough to expose the whole length of the
compartments. The incision lies approximately
over the anterior intermuscular septum that
divides the anterior and lateral compartments
and allows easy access to both.
Double-incision fasciotomy
A small incision is made in the fascia of the
anterior compartment, midway between the
septum and the tibial crest. The fascia is
opened proximally and distally, respecting any
visible superficial nerve.
Double-incision fasciotomy
The lateral compartment fasciotomy is in line
with the fibular shaft. Directing the scissors
towards the lateral malleolus helps avoid the
superficial peroneal nerve as it exits from the
fascia in the distal third of the leg near the
septum and courses anteriorly. Look for this
nerve, which may be branched, and protect it.
Single incision fasciotomy
Technique
A) An incision is made from the fibular neck to
the lateral malleolus.
Note
Protect the common peroneal nerve as it
crosses the fibula proximally, and the superficial
peroneal nerve distally.
B) The lateral compartment (LC) is opened.
C) Retracting the anterior skin exposes the
fascia of the anterior compartment (AC),
which is opened, with care being taken to
avoid the superficial peroneal nerve (SPn).
Single incision fasciotomy
D) The posterior skin is retracted to expose the
fascia of the superficial posterior
compartment (SPC), which is opened.
E) The lateral compartment is retracted
anteriorly. The soleus is released from the
fibular shaft and is retracted posteriorly,
exposing the fascia of the deep posterior
compartment (DPC), which is opened.
Confirm that the deep posterior compartment
muscles are released by passively extending
and flexing the great toe. This motion changes
tension in flexor hallucis longus, which should
be felt easily through the open fasciotomy.

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