Ollier Approach to Sinus Tarsi

Ollier Approach indications:

The Ollier approach is excellent for a triple arthrodesis, where the three joints are exposed through a small opening without much retraction, and the wound usually heals well because the proximal flap is dissected full thickness and the skin edges are protected during retraction.

Position of the Patient

The patient is positioned Supine with bump under buttock.

Landmarks and Incision

• Make a 8-10 cm curved incision:
• Begin incision over dorsal-lateral talonavicular joint.
• Extend posteriorly over the sinus tarsi (soft tissue depression just anterior to lateral malleolus).
• Incise obliquely to point 2.5 cm below tip of lateral malleolus.

Internervous plane

The Internervous plane for Ollier Approach lies between:

• Peroneus tertius muscle: which is innervated by the deep peroneal nerve.
• Peroneus brevis muscle: which is innervated by the superficial peroneal nerve.

Superficial dissection

• Incise fascia and divide inferior extensor retinaculum in line with incision.
• Ligate veins crossing operative field.
• Mobilize small flaps (large flaps may necrose).
• Incise deep fascia and extensor retinaculum in line with incision: careful not to damage peroneus tertius and extensor digitotum longus.
• In the superior (distal) part of the incision expose peroneus tertius and EDL and retract medially.
• In inferior part of incision expose peroneal tendons and retract inferior.

Deep dissection

• Partially resect fat pad over sinus tarsi with sharp dissection (leave attached to skin flap).
• Identify and detach origin of extensor digitorum brevis under fat pad.
• Reflect extensor digitorum brevis distally.
• Identify and incise dorsal capsule of talocalcaneonavicular joint.
• Identify and incise capsule of calcaneocuboid joint.
• Incise peroneal retinacula and reflect peroneal tendons anteriorly.
• Identify and incise capsule of posterior talocalcaneal joint.

Dangers

The structures at risk during The Ollier approach include:

1. Skin flap necrosis: keep skin small and thick and avoid sharp curves.
2. Extensor digitorum longus tendon.
3. Peroneus brevis tendon.

References

• Campbel’s Operative Orthopaedics book 12th