- Anatomy:
-
anterior compartment
-
lateral compartment
-
deep posterior compartment:
-
superfical posterior
- Anatomy:
- position: either prone or on side, with the affected extremity uppermost;
-
incision:
- incision is made just posterior to the fibula along the lateral border of the gastrocnemius;
- cutaneous branch of the peroneal nerve must be protected;
-
inter-neural plane:
- access to
deep posterior compartment is between
lateral and
superficial posterior compartments;
- develop plane between
superficial compartment posteriorly & peroneal muscles anteriorly;
- detach the distal part of the origin of the soleus from fibula & retract it posteriorly and medially;
- develop plane between
FHL posteriorly & peroneal muscles anteriorly;
- attachments of the FHL to the posterior surface of the fibula are freed;
- once the FHL is cleared off of the fibula, take care to avoid the
peroneal artery (disssection proceeds between FHL and fibula);
- direct dissection toward interosseous membrane;
- detach tibialis posterior from interosseous membrane;
- posterior tibial artery & tibial nerve lie in protected position behind
tibialis posterior & FHL;
- continue dissection along interosseous membrane to lateral border of tibia;
- detach subperiosteally muscles that arise from posterior surface of tibia;
- posterior surface of tibial shaft may be completely exposed, except for the proximal fourth which should remain intact (gives rise to
popliteus);
