Editing Lower extremity amputation operatives (section)

== '''Hip disarticulation''' ==

* Technique:
** Semilateral position
** Anterior racquet incision (2.5cm medial to ASIS, extending towards the pubic tubercle, and continues posteriorly distal to the ischial tuberosity and gluteal crease, then anteriorly, medial to the greater trochanter and AIIS before joining back at the origin) or a posterior long flap incision
** Skin and soft tissues incised down to external oblique aponeurosis and deep fascia of the thigh
** Femoral vessels suture ligated and the femoral nerve transected and allowed to retract
** Hip joint muscles are divided, starting with the sartorius at its origin and iliopsoas at its insertion. Pectineus divided at its origin. Gracilis and three adductors are divided at their origins. Obturator neurovascular bundle is divded. Obturator externus muscle divided at its insertion. Hamstrings transected at the ischial tuberosity. TFL, gluteus maximus, and rectus femoris divded. 
** Ligamentous attachments and capsule of the hip divded.
** Sciatic nerve transected and allowed to retract
** Specimen passed off
** Posterior quadratus femoris sutured to anterior iliopsoas and lateral gluteus medius sutured to medial obturator externus
** Subcutaneous closed suction drains
** Gluteal fascia sutured to inguinal ligament and skin loosely closed with staples
** Prevena works well.