Foot and Ankle Surgical Approaches Flashcards
1
Q
Anterior approach to the ankle (Positioning, 3)
A
- Place supine
- Elevate for 3-5 min or rubber bandage to calf
- Thigh tourniquet
2
Q
7 steps of anterior approach to the ankle
A
- 15 cm Longitudinal incision over anterior aspect of ankle joint. 10 cm proximal to the joint
- Identify and protect superficial peroneal nerve
- Incise the extensor retinaculum in line with skin incision
- Identify plane between EHL and EDL
- Retract EHL medially with neurovascular bundle. Retract EDL laterally. Neurovascular bundle - Deep peroneal nerve and anterior tibial artery.
- Incise joint capsule longitudinally
- Retract joint capsule to expose ankle joint
3
Q
Uses of anterior approach to the ankle (4)
A
- Ankle arthrodesis
- I & D of ankle joint
- Removal of loose bodies
- ORIF of comminuted tibial pilon fractures
4
Q
Dangers with anterior approach to the ankle (3)
A
- Cutaneous branches of the superficial peroneal nerve (medial dorsal cutaneous nerve) are at risk during skin incision
(Anterior neurovascular bundle)
- Deep peroneal nerve
- Anterior tibial artery
at risk during skin incision
5
Q
Proximal extension of the anterior approach to the ankle
A
Use one between the tibia and Tibialis anterior after incising the Extensor retinaculum
6
Q
Lateral approach to the Lateral Malleolus (Positioning - 5)
A
- Place supine
- Place sandbag under ipsilateral buttock
- Can also tilt table away from surgeon
- Exsanguinate by elevating 3-5 min
- Inflate tourniquet
7
Q
Lateral approach to the lateral malleolus (5 steps)
A
- 10 - 15 cm incision along posterior margin of the fibula. (Danger - superficial peroneal nerve - medial dorsal cutaneous nerve lies anterior to the tibia)
- Curve the incision forward about 2 cm distal from the tip of the lateral malleolus
- Elevate skin flaps (Danger- short saphenous vein and sural nerve run together posterior to the lateral malleolus)
- Incise the periosteum on the fibula longitudinally
- Expose the distal fibula subperiosteally
