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LATERAL APPROACH TO THE DISTAL THIGH
USES
This approach is used for supracondylar fractures and for releasing the iliotibial band in iliotibial-band friction syndrome. The fascia lata can be easily harvested or the iliotibial band lengthened through this incision. Additionally, by moving the incision slightly posterior, it is possible to do a biceps femoris release, lengthening, or transfer.
ADVANTAGES
This approach does not put any nerve or artery at risk.
DISADVANTAGES
There are no disadvantages if this approach is used for the purposes for which it is intended.
STRUCTURES AT RISK
There are no significant structures at risk. The fascia lata and iliotibial band are split longitudinally, but that usually is the point of the approach.
It is potentially possible to damage the peroneal nerve, but only if you are seriously lost medially and posteriorly. As long as you stay anterior to the biceps femoris, there is no risk.
TECHNIQUE
A straight incision is made from the femoral condyle area proximally. It is carried through subcutaneous tissue. The iliotibial band is identified and split, and the vastus lateralis is apparent underneath it. The lateralis should be stripped off the intermuscular septum and retracted in a medial direction, exposing the lateral femoral shaft and the lateral femoral condyle. It is important to stay out of the knee joint by coming from underneath and lifting the joint capsule and synovium anteriorly.
If the goal is to release the hamstrings, then the posterior border of the iliotibial band is identified and the biceps fascia is split just behind it, exposing the muscle of the biceps. The short head of the biceps originates off of the femur in this area and will need to be stripped off of the femur to expose the medial border of the biceps. This will allow the peroneal nerve to be identified and protected prior to doing any harvesting or lengthening of the biceps femoris.
TRICKS
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