Dolph Houben

38 CHAPTER 2 Figure 1: pre-operative outline of the fibula by palpation, the to be harvested segment should include the middle 1/3 part of the fibula to include the nutrient artery (1), a longitudinal skin incision is made and the fat stripe between the peroneus and soleus muscle identified (2), Blund dissection of this interval is made beginning in the middle 1/3 of the bone (3), dissection is continued proximately and the soleus detached of its origin and the peroneal vessels identified (4), the peroneal nerve is then identified at the neck of the fibula and the lateral compartment muscles elevated (5), a subperiosteal dissection is carried out proximately and the proximal osteotomy is made (preferably with a Gigli saw) while protecting the neurovascular structures (6).