Maquet osteotomy can be associated with an unacceptably high incidence of wound complications that may be as high as 37%. A consecutive series of 42 Maquet osteotomies has been performed between 1990 and 2002 by a single surgeon without a single wound problem or infection and this series is the subject of this report. The use of an anterolateral incision reduces the damage to the major lymphatics minimising the risk of wound oedema. Identification and preservation of the feeding musculocutaneous vessels on the lateral and medial sides facilitates extensive but safe mobilisation of the skin flaps permitting an easy closure over a substantially elevated tibial tubercle. The use of an anterolateral incision with knowledge of the blood supply of the leg has eliminated the wound complications associated with the standard anteromedial incision reported previously in the literature. This approach, preserving the blood supply and lymphatic drainage, avoids skin necrosis and wound dehiscence, obviates any requirement for plastic surgical procedures such as releasing incisions or skin grafts and minimises the risk of infection and osteomyelitis.