Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

FIGURE 30-11.  Next, the dorsal incision is deepened through the subcutaneous tissue. The dorsalis pedis vessels are identified and cauterized, and all the tendons and nerves are pulled distally, sectioned, and allowed to retract proximally. This exposes the anterior ankle joint, which is now cut open completely. Working carefully between the talus and the medial malleolus, the deltoid ligament is cut, freeing the medial aspect of the ankle joint. Care is necessary here to avoid damage to the posterior tibial artery and vein. Working on the lateral side of the ankle, the surgeon cuts the tibiofibular ligaments. The only remaining portion of the ankle capsule remaining is posterior.