- Discussion::
-
iliotibial band (and thin fascia covering
maximus) are incised in line w/ the incision;
- in most cases, the hip is kept in midflexion for both the skin incision and the IT band incision;
- if the hip is repositioned in extension after the skin is marked out, the dissection thru the
subcutaneous tissues will often proceed too far posteriorly;
- if the hip is kept flexed during the dissection, then the dissection will procede over the
center of the trochanter;
- use periosteal elevator to sweep subQ tissues away from either side of the
IT band, especially anteriorly;
- incise the
iliotibial band in line w/ its fibers, beginning at distal end of
the wound & extending proximally to greater trochanter;
- if the incision is made too deeply the
vastus lateralis will be entered;
- proximally, divide fascia lata & thin fascia covering
maximus superiorly;
- the fascial covering of the
maximus varies considerably in its
thickness, and in the elderly is quite thin;
- once the fascia thins out, bluntly split the fibers of the maximus to the
apex of the incision;
- often bleeding is encountered as the maximus is split;
- once the IT band has been split, the surgeon will find an attachment of the IT band
to the femur at the most distal part of the wound (not to be confused w/ the
gluteus sling);
