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POSTEROMEDIAL APPROACH TO THE CALF

USES

This approach is used primarily for release of the posterior compartments in compartment syndromes. It is also used for release of the posterior tibial muscle off of the tibia in cases of periostitis causing posteromedial pain.

ADVANTAGES

This is a direct approach for the purpose of releasing the posterior compartments.

DISADVANTAGES

This approach provides no exposure laterally and requires a second lateral incision for complete release of all compartments.

STRUCTURES AT RISK

There are no structures at risk with this approach until you are in the deep posterior compartment. The saphenous nerve and vein are subcutaneous and usually easily retracted. The posterior tibial nerve and artery run along the anterior, that is, the deep border of the soleus, and need to be identified. There are descending branches to the posterior tibial and toe flexor muscles and these branches should be preserved.

TECHNIQUE

An incision is made 1 cm posterior to the posteromedial corner of the tibia, cutting as far proximally and distally as necessary to achieve the desired exposure. The incision is carried through the subcutaneous tissue, exposing the muscle belly. The overlying fascia is split. The interval between the posterior tibialis and gastrocnemius soleus complex is identified and developed. All compartments are opened by splitting the fascia.

TRICKS

The major trick is to identify all of the compartments. The interval between the gastrocnemius and soleus is easily developed and seen in Figure 43–3. The soleus comes off the back of the tibia, actually overlying the origin of the flexor digitorum longus, which is seen in Figure 43–4 overlying the posterior tibialis (this is the deepest of the muscles). The flexor digitorum longus is the first muscle encountered when dissecting directly behind the tibia. The flexor hallucis longus is a more lateral structure coming off of the interosseous membrane and fibula proximally.

HOW TO TELL IF YOU ARE LOST

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterior Approach Anterolateral (Internervous) Approach Posterior Approach Anterior Approach to the Cervical Spine

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