Extended lateral approach for elective hind foot surgery—A safe and versatile incision David Thyagarajan FRCS*, Ganesh Walkey MRCS, Andrew Kelly FRCS (Orth), Ian Winson FRCS (Orth) Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, UK 1. Introduction Palmer popularized the lateral approach to the hind foot in 1948 and he reported 90% good results in the treatment of calcaneal fractures [1]. No one so far has reproduced these results [2,3]. The direct lateral approach has been modified since the original description. The direct lateral incision described by Stevenson as a modification of the original Kocher’s incision begins just proximal and posterior to the tip of fibula and curves at the level of the floor of sinus tarsi and extends distally to the calcaneocuboid joint. This approach is associated with frequent wound edge necrosis and sural nerve damage [4]. The extended lateral approach has been well described in the past and it is in fact a fasciocutaneous flap based on the terminal branch of peroneal artery and extensive studies have been published, describing the anatomical basis and surgical implica- tions following its use in treatment of calcaneal fractures [5,6]. Previous studies comparing the direct lateral incision with the extended lateral approach reported excellent wound healing potential and no major sural nerve problems with the extended lateral approach [7]. A more recent study comparing this approach with a limited subtalar lateral approach has highlighted the extensive nature of the dissection and reported complications which include wound infection, haematoma, dehiscence and sural nerve damage [8]. So far there has been no reports of the outcome following the extended lateral approach in elective hind foot surgery. We aim to review our experience of the extended lateral approach to the hind foot in treatment of non-traumatic foot disorders with particular reference to wound complications. 2. Patients and methods We retrospectively evaluated 51 consecutive patients who underwent elective hind foot surgery using the extended lateral approach. They had all been treated in the foot and ankle service of a single, large teaching hospital. The mean age of the patients was 47.9 (range 15–84). There were 32 woman and 19 men. The follow up was at 2 weeks, 6 weeks, 3 months, 6 months and 1 year post- surgery. Indications for surgery, co-morbidity, quality of wound healing, and other wound related problems were recorded. 2.1. Surgical approach The operative exposure is similar to that previously described [6]. The two incisions (Vertical and horizontal limb) meet at the lateral side of the heel with an angle not less than 1008 (Fig. 1). The vertical Foot and Ankle Surgery 17 (2011) 274–276 A R T I C L E I N F O Article history: Received 23 January 2010 Received in revised form 3 October 2010 Accepted 12 October 2010 Keywords: Extended lateral approach to hindfoot Hindfoot surgical approach Hindfoot surgery A B S T R A C T Aim: The aim of our study was to review our experience of the extended lateral approach to the hind foot in treatment of non-traumatic foot disorders with particular reference to wound complications. Materials and methods: We retrospectively reviewed 51 consecutive patients who under went extended lateral approach to the hind foot for treatment of various non traumatic foot disorders. We documented the indication for surgery, co-morbidity, quality of wound healing and other wound related problems. Results: The mean age was 47.9. There were three superficial wound infections (5.8%). One had slight sensory loss close to the scar, one developed hypersensitivity over the scar. There was no wound break down or any deep infection. No sural nerve deficit was noted. Six patients had the calcaneal screw removed due to prominent metal work (11.7%). Conclusion: The extended lateral approach to hind foot is safe in the surgical treatment of a wide variety of non-traumatic foot conditions. Despite the larger deep dissection, the arterial anatomy ensures reliable wound healing and a low incidence of wound complications. ß 2010 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. * Corresponding author at: 29, Sabrina Way, Stoke Bishop, Bristol, BS9 1ST, UK. Tel.: +44 781 5785916; fax: +44 117 9681212. E-mail address: davidskt@yahoo.co.uk (D. Thyagarajan). Contents lists available at ScienceDirect Foot and Ankle Surgery jou r nal h o mep age: w ww.els evier .co m/lo c ate/fas 1268-7731/$ – see front matter ß 2010 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.fas.2010.10.002