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Introduction
  • Indications
    • Treatment of infected cases of nonunion
    • Treatment of chronic osteomyelitis
    • Bx and treatment of bone tumors
    • Exploration of the sciatic nerve
Intermuscular plane
  • Between
    • lateral intermuscular septum which covers vastus lateralis (femoral nerve)
    • biceps femoris (sciatic nerve)
Approach
  • Position
    • prone
  • Incision
    • Longitudinal (20 cm) down the midline of the posterior aspect of the thigh

  • Superficial dissection
    • Deep fascia of the thigh
    • avoid posterior femoral cutaneous nerve


  • Deep dissection
    • Begin proximally; retract the long head of biceps femoris medially and lateral intermuscular septum laterally
    • In the distal half, retract the long head of the biceps laterally to expose the sciatic nerve; retract the sciatic nerve laterally 
    • excise periosteum longitudinally
    • expose desired area of femur with subperiosteal dissection






Dangers
  • Posterior femoral cutaneous nerve
  • Sciatic nerve
  • Nerve to biceps femoris
 

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