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Medial approach

Incision

Start the incision 2 cm distal to the anterior tip of the medial malleolus. Curve the incision towards the anterior edge of the medial malleolus and in the direction of the middle of the distal tibia.

Find the saphenous vein and nerve, and use a vessel loop to retract them.

The dotted line illustrates an alternative skin incision that may be used, where more anterior access is required. Take particular care not to divide the saphenous vein and nerve, which are more vulnerable with this incision.