ACCORDING to Elkin and Kelly,176 a near disaster from hemorrhage of the posterior tibial vessels in the course of the excision of an arteriovenous aneurysm prompted the approach to these vessels by the removal of the upper portion of the fibula, including the resection of the head of that bone where necessary. The rich collateral anastomosis which develops as the result of an arteriovenous communication, together with dilatation of the vessels, including those which perforate the interosseous membrane, demands direct visualization of these vessels and their careful ligation and division. Otherwise the retraction of vascular channels through the interosseous membrane may result in serious or even uncontrollable hemorrhage and necessitate a second incision along the front of the leg or the removal of the fibula in the presence of hemorrhage and at an inopportune time during the course of the operation.
The exposure of the fibula and the method
LEWIN P. PROGRESS IN ORTHOPEDIC SURGERY FOR 1945 A Review Prepared by an Editorial Board of the American Academy of Orthopaedic SurgeonsVIII. INFECTIONS OF THE BONES AND JOINTS. Arch Surg. 1947;54(3):324–349. doi:10.1001/archsurg.1947.01230070330007