Piermattei's Approaches - Pelvic Limb

Question 1

Approach to the hip through a craniolateral approach

Answer 1

Approach
- Incise skin just cranial to the femur, centered on the greater trochanter
- Incise through the superficial fascia along the cranial border of the biceps femoris
- Incise the deep fascia to free the TFL
- Continue the incision proximally between the superficial gluteal and the TFL
- Retract the superficial, middle and deep gluteals proximally
- Incise into the joint capsule and continue laterally along the neck of the femur
- Elevate a portion of the vastus lateralis if necessay

Question 2

Approach to the shaft of the femur

Answer 2

Approach
- Incise the skin along the craniolateral border of the femur
- Superficial leaf of the fascia lata is incised along the cranial border of the biceps femoris and extended the full length of the skin incision (if muscle fibres are encountered, move more cranially)
- Retract the vastus lateralis by elevating it from the bone and retracting it cranially

Question 3

Approach to the distal femur and stifle joint through a lateral incision

Answer 3

Approach
- Curved parapatellar incision from the tibial tuberosity to the patella and equidistant proximally
- Incise along the same line through the fascia lata and along the cranial border of the biceps femoris
- Continue the incision distally into the lateral joint fascia
- Separate the biceps from the vastus lateralis by severing an intermuscular septum
- Incise the joint capsule

Question 4

Approach to the stifle joint through a medial incision

Answer 4

Approach
- From the tibial tuberosity to the patella and equidistant proximally
- Arthrotomy incision follows the same line, just medial to the patellar ligament
- Incise the joint capsule between the distal pole of the patella and the tibia
- Enter the joint at the proximal aspect of this incision to prevent articular damage
- Extend the arthrotomy with metzenbaum scissors proximomedially and distally

Question 5

Approach to the proximal tibia through a medial incision

Answer 5

Approach
- Incise the skin from the patella across the joint, over the MCL and to the proximal third of the tibia
- Cut along the cranial edge of the sartorius m and incise the pes anserinus (sartorius, gracilis, semiten)
- Expose the medial cortex, taking care to avoid the collateral ligament
- Incise along the cranial and caudal border of the tibial shaft to elevate the cranial tibial and popliteus mm respectively

Question 6

Approach to the shaft of the tibia

Answer 6

Approach
- Incise the skin along the medial shaft
- Can preserve the saphenous veins and nerve
- Incise the crural fascia
- Elevate the cranial tibial muscle cranially and the flexor muscles caudally

Question 7

Approach to the calcaneus

Answer 7

Approach
- Skin incision on the lateral aspect from the CCT and continues down the bone to the 4th tarsal bone
- Lateral border of the SDFT is located and an incision is made in the fascia lateral to it
- Incision continues proximally to allow separation from the gastroc tendon