When anteriorly crossing the tibial crest a mark should be made in bone for future reference. The posterior incision is deep within the fascia until the level of intended bone resection is reached. As the anterior flap contracts, the previous mark on the tibia is used as a reference point for bone resection. A curved haemostat is inserted and the superficial peroneal nerve is isolated. The anterior muscles are divided 0.6 cm distal to the point of bone resection to allow for contracture.
Care is taken with blood vessels and the deep peroneal nerve.
The blood vessels are then ligated. The tibia is resected transversely and the fibula, 1.2cms proximally from the tibia resection. The gastrocnemius muscle mass is bevelled so as to form a myofascial flap long enough to reach across the end of the tibia to the anterior fascia. The ends of the bones are smoothed and release of the haemostat will identify vessels that need ligation. Alternately, a myodesis may be performed where pre-attachment of the muscles to the actual bone is performed.