Ortho Oracle - orthopaedic operative atlas
Home » Bones » Tibia and Fibula » THR: Incision thru Iliotibial Band

THR: Incision thru Iliotibial Band

- 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 
    - 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)