Introduction
Describe indications and point out major advantages or disadvantages of approach
Position of patient
Prone on bolsters for chest.
Landmarks and incision
Along lateral side of biceps femoris, curvilinear across popilteal fossa, down medial gastrocnemius
Internervous plane
Insert description
Superficial dissection
Identify Medial Sural Cutaneous nerve (and short saphenous vein) inferiorly
Follow this superiorly incising fascia to apex of popilteal fossa [distal to proximal]
Deep dissection
Apex bounded by semimembranosus medially & biceps femoris laterally
Identify & protect common peroneal nerve starting at apex under biceps femoris and going distally [proximal to distal]
Identify tibial nerve, popliteal vessels deep at apex
5 branches of artery (2 superior, 2 inferior, 1 medial geniculate) - may have to ligate some for access
Posterolateral Corner
- Incise tendinous lateral head of gastrox off femoral condyle & retract it inferomedially
- Neurovascular bundle goes under & is protected by lateral head of gastrocnemius
Posteromedial Corner
- Incise tendinous medial head of gastrox off femoral condyle & retract it inferolaterally
- Neurovascular bundle goes under & is protected by medial head of gastrocnemius
Dangers
Insert description
How to enlarge the approach
Insert description
Keys
Medial sural cutaneous nerve superficially leads into popilteal fossa (distal to proximal)
Common peroneal nerve under biceps femoris (proximal to distal)
Identify +/- ligate neurovascular bundle proximally & deep
Take down either head of gastrocnemius for access to that corner
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