Kocher approach



- Discussion:
    - allows access to midtarsal, subtalar, & ankle joints;
    - disadvantages:
          - skin may slough about  margins of the incision, especially if dislocation of ankle is a part of the case (as in talectomy);
         - further the peroneal tendons must usully be divided;
         - in most instances the anterolateral incision is more satisfactory;
    - incision:
         - begins  just lateral & distal to head of talus, curves about 1 inch inferior to tip of lateral malleolus, then continues posteriorly & proximally, and to end about 1 inch posterior to fibula & 5 cm proximal to tip of lateral malleolus;
               - if needed incision may continue or, if desired, 5-7 cm further proximally, parallel with and posterior to fibula;
    - deep exposure:
         - dissect  down to peroneal tendons and retract them posteriorly;
         - this protects lesser saphenous vein & sural nerve lying just posterior to the incision



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 13, 2012 3:35 pm