Baumann gastroc recession

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Creflo

time to eat
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Any pearls on how to avoid the sural nerve with this procedure? Also, when making the cut, do you cut more proximal as you go lateral since the lateral head of the gastroc ends more superiorly than the medial head?

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Exactly how are you performing this procedure?

I see technique guides describing a midline incision but in reality most docs I've seen (even Lamm who wrote about the midline incision) are now performing this from the postero or antero-medial side, just inferior to the medial head of the gastroc. The area released are the anterior (deep) gastroc apaneruosis as well as the posterior (superficial) soleus. The way we've performed the procedure is transverse with a fasciotome or blade.
 
I made incision approximately 1.5 thumb lengths posterior to the medial tiba crest, from the inferior border of the medial head of the gastroc extending approximately 5cm proximally. Dissect through the subcutaneous and deep fascia then use fingers to separate gastroc from soleus. Retract, have headlight, use long knife handle with 15 blade and cut anterior fascial covering of gastroc (sharp edge of blade faces posteriorly) all the way across. Again, the concern with this is to avoid the sural. Did one last week that went well, but never visualized the sural.
 
Any pearls on how to avoid the sural nerve with this procedure? Also, when making the cut, do you cut more proximal as you go lateral since the lateral head of the gastroc ends more superiorly than the medial head?
Just for discussions sake, why do a Baumann as opposed to a more distal gastroc recession?
 
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