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Direct Anterior Approach to the Hip Joint
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
The rectus fascia is incised longitudinally and mobilised for a centimetre or two from the unnamed fascia lying deep in the muscle. Several small vessels enter the muscle here and can be diathermied. The self-retaining retractor is then moved to retract the rectus anteromedially from the deeper fascial layer. Beneath this fascia lie the large ascending branches of the medial circumflex femoral artery and vein. They are most often visible through the fascia. They must be identified and tied before they are divided, as they may bleed profusely (Fig. 17.6).
Profunda femoris artery perforator flaps: a detailed anatomical study
Published in Journal of Plastic Surgery and Hand Surgery, 2020
As the topographical points, we identified the ischium, greater trochanter, coccyx, inferior gluteal fold, transverse line (between trochanter and coccyx), and the lateral and medial femoral condyles (Figure 1(A)). Primarily, PTR was divided into two parts as a proximal and distal. The proximal portion of the PTR was regarded for the PFA and its branches, which are the lateral circumflex femoral artery (LCFA) and the medial circumflex femoral artery (MCFA). Since the PFA and its branches end at this level, the distal part of the PTR was excluded in this study. Then, using a mid-vertical line, the PTR was divided into the medial and lateral regions (Figure 1(B)). A T-shaped incision of a 20-cm length was made to the skin along the infragluteal and mid-vertical lines. We followed all perforators retrogradely to the leading source artery. We used photographs for recording each stage of the dissection and recorded the perforators larger than 0.5 mm diameter in size.
Arthroscopic versus open, medial approach, surgical reduction for developmental dysplasia of the hip in patients under 18 months of age
Published in Acta Orthopaedica, 2019
Serda Duman, Yalkin Camurcu, Hakan Sofu, Hanifi Ucpunar, Deniz Akbulut, Timur Yildirim
Simple closed reduction is the first-line treatment for DDH in patients aged 6 months to 1 year (Race and Herring 1983, Terjesen and Halvorsen 2007). Open reduction should be considered only if closed reduction cannot be performed. Medial open surgical reduction is a choice for the management of patients younger than 18 months with DDH. The minimal incision and minimal blood loss are advantages of this approach. Limited exposure of the hip joint is a disadvantage. Several studies have described successful outcomes with this technique (Morcuende et al. 1997, Okano et al. 2009). However, injury to the medial circumflex femoral artery with consequent avascular necrosis (AVN) of the femoral head is the most important risk associated with the medial approach open reduction (Pospischill et al. 2012). Reportedly, re-dislocation, possible need for secondary pelvic osteotomy (secondary to limited acetabular re-modeling), limitations of ROM, and subsequent lateralization of the femoral head are other possible complications.
Use of the profunda artery perforator flap in vulvo-perineal reconstruction
Published in Journal of Obstetrics and Gynaecology, 2018
S.S. Jing, B. Winter-Roach, D. Kosutic
Knowing the vascular anatomy, perforators to the PAP flaps can easily be located. Often the pedicle needs to be no more than a few centimetres long, due to the close proximity of the flap to the perineal defect. This minimises the dissection time. Harvesting the PAP flap is a muscle sparing technique that offers a good volume of quality tissue, particularly in women, that can withstand adjuvant radiotherapy if required. Two PAP flaps can be raised for larger defects. This preserves the alternative flaps based on the pudendal artery, medial circumflex femoral artery and gluteal arteries for future harvest should the tumour recur. From our experience, the PAP flap presents an excellent option for perineal reconstruction for these reasons. It allows the surgeons to achieve the aesthetic and functional ideal without it being technically demanding for a good long-term result.