Name:
'Z-Plasty' of Tensor Fascia Lata for Snapping Hip
Description:
'Z-Plasty' of Tensor Fascia Lata for Snapping Hip
Thumbnail URL:
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Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/7025395e-e255-450b-be7b-1e81f189726c
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/7025395e-e255-450b-be7b-1e81f189726c/%27Z-Plasty%27 of Tensor fascia Lata for Snapping Hip.mp4?sv=2019-02-02&sr=c&sig=GGe%2B7r3a2%2BK1q9ANki4MYHHJuF7zUcKyY14Xb%2FZTlh4%3D&st=2024-11-21T15%3A16%3A33Z&se=2024-11-21T17%3A21%3A33Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, well with us today, I'm going to show you an interesting operation for the condition, which is called external snapping of hip. And these patients usually report clicking in pain across the side of the hip. Now, if you're visiting my channel for the first time, I would request you to kindly subscribe to the channel.
Please press the bell icon so that you get notification for any new videos and also share it with your fellow friends so that they can benefit from the videos that I've already posted. Now today I'm going to do a Z-Plasty of EFL for an external snapping, and my goal is to take you through step by step as how to do this procedure so that the pain and symptoms of the patient can be relieved.
So our position for this particular surgery will be the lateral position so the patient will be lying on the side so that we have got easy access of the greater trochanter. Of course I'm going to operate from this side. My trolley is on my right hand side. So the next step will be to demonstrate the snapping, if I can, because sometimes you cannot see the snapping when a patient is asleep.
And also to show you the Ober's test, to show how tight it is. So to that, our patient today is a 27-year-old gentleman who is complaining a lot of pain over the greater trochanter and a snapping sound. And on examination, it was clearly able to demonstrate the snapping. And if I can show you there's a lot of swelling across it here. You will see a lot of patients who have got snapping, but they are usually not that painful.
But this guy had a lot of pain and swelling. Now, first thing you do I want to show you is the snapping. But a lot of times you will not be able to demonstrate that when patient is asleep. So attack the leg and then try to externally rotate it. If you feel a snapping, I can feel it on my hand, but I'm not able to demonstrate the snapping that is seen in this patient when he was awake. And if I show you the Ober's test and I've already uploaded a video showing the snapping and Obers' test, you can refer that this is really tight, so it is positive.
So the next step will be to mark our skin incision. So I have marked a greater trochanter for you. This is the tip, this is the front. This is the back. It's always a good practice to mark your skin incision. Now our skin incision will be centered over the trochanter and you can see the majority of the swelling is here. Now, I have made it slightly longer, but usually you can get away with around 10 centimetres. This is somewhere around 11 to 12 centimeters.
The key is to get the incision. This is one third and this is roughly 2/3. So you don't want to be going too much up because you just have got muscles and the fascia is not there so unnecessarily don't go approximately. After this, your next step is to take the skin down. So just straight line. And I've uploaded several videos of this region, so there's nothing much interesting here except we are going to find we are going to take skin down, we are going to take the subcutaneous tissue and fat down, and then we'll start seeing the fascia.
So once I have reflected the fat and once I'm onto the fascia, I'll join you back. So so far we have taken the skin, subcutaneous tissue and fat layer. I have used periosteum. This is a very good periosteum and deflected the fat, both front as well as back. So this is the step I have not shown because it's pretty straightforward.
Just use a periosteum and reflect the layer of fat. The reason is you want to be seeing the fascia quite clearly. Now you can see the round thing. This is your GT. So this is roughly the centre of the GT. This is the front part of the fascia. This is you can feel the back part of the fascia. Now, once you have exposed the front and back of the fascia, you are ready for your next step that is making the Z of the Z-Plasty.
If you understand the pathophysiology of this external snapping, you would know that usually it is the anterior part of the fascia which goes in and out and causes pain and symptoms and that is responsible clicking. So when you're making your incision for the fascia, it's usually around 8 centimetres long. You can make it slightly shorter or longer depending upon the size of the patient, but I think 8 centimetres is a good size incision.
This is the centre, this is the front of the trochanter. This is the back of the trochanter. I'm going to make my incision slightly.....
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