OrthoNet

Acetabulum - ilioinguinal approach

• position - supine with GT @ edge of table
- need catheter

• incision - curved ant. Incision starting 5cm above ASIS
- 1cm above pubic tubercle to midline

* no internervous plane

* dissection
- incise subcut. fat
- expose aponeuroses of ext. oblique
- lat. fem. cut. n. in lat. edge of dissection
- divide ext. oblique from superficial inguinal ring to ASIS
- ID round lig. or spermatic cord = med. bundle
- divide ant. part of rectus sheath to expose underlying rectus
- strip iliacus from inside of wing of ilium –> can expose SI joint
- divide rectus transversely 1cm prox. to insertion
- develop plane btw back of symphysis & bladder = space of Retzius)
- peel fibers of int. oblique & transversus from inguinal lig. –> avoids inf. epigastric art. & deep inguinal ring
- push peritoneum upwards to expose ext. iliac vessels
- isolate ext. iliac vessels = middle bundle
- isolate iliopsoas & fem. n. = lat. bundle
- expose med. surface of acetabulum & sup. pubic ramus

* dangers
- fem. n. - runs beneath inguinal lig. lying on iliopsoas; avoid excessive retraction

- inf. epigastric art. - passes med. to deep inguinal lig.

- spermatic cord - contains vas deferens & testicular art.

- bladder - easily mobilized off back of symphsis

- corona mortis
> anastomosis of branch of obturator art. & ext. iliac art.
> occurs in 25-30% of patients
> on undersurface of ext. iliac art.