From the Research
The recommended approach for surgical exposure of the anterior tibial region is an anterolateral incision, placed approximately 1-2 cm lateral to the anterior tibial crest. This approach is preferred due to its ability to minimize the risk of wound complications and provide excellent access to the anterior and lateral aspects of the tibia. The incision should begin at the appropriate level based on the pathology being addressed and extend distally as needed, typically 8-12 cm in length.
Key Considerations
- The incision should be made through skin and subcutaneous tissue, taking care to identify and protect the superficial peroneal nerve which may cross the surgical field distally 1.
- After the skin incision, the fascia overlying the anterior compartment should be incised, and the interval between the tibialis anterior and extensor digitorum longus muscles should be developed.
- This approach allows for plate placement on the lateral surface of the tibia, which provides better soft tissue coverage for hardware and reduces the risk of postoperative irritation and the need for subsequent hardware removal.
Alternative Approaches
- A medial approach to the anterior tibial artery has been described, which involves a medial incision and retraction of the posterior tibial muscle to expose the interosseous membrane 2.
- A posterior approach has also been described, which involves a single posterior incision to access both the popliteal and anterior tibial arteries 3.
Limitations and Potential Complications
- The anterolateral approach may not be suitable for all patients, particularly those with extensive scarring or limited autogenous vein availability.
- The use of a vein graft may be necessary in some cases, which can decrease flow to the graft and increase the risk of complications 4.