Dissection of the Anterior and Medial Thigh
Dissection of the Anterior and Medial Thigh
Dissection of the Anterior and Medial Thigh; Anterior and Lateral Leg and Dorsum of the Foot
The dissection process starts by doing an incision using a surgical blade at the level of lingual ligament form the lateral to medial aspect. Next, we do a shallow midline incision along the front of anterior thigh. The incision needs to be superficial in order to be able to identify some vessel that are located superficially like the superficial fibular nerve. The next step is do an incision on the anterior leg. The incision should align with the tibial ridge at the front of tibia in order to maintain all structures. A horizonal incision is done at the end of the knee. Another horizontal incision made at the superior extensor retinaculum. The skin is reflected back and slowly opened by cutting the attachment between the skin and superficial fascia. The extra pieces of superficial fascia in removed by scissors to uncover the superficial muscles. The longitudinal incision is continued upwards toward the knee to meet the incision on the anterior thigh.
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The incision is extended into the dorsum of the foot until the upper level of meta tarsals. We do another horizontal incision in the dorsum of the foot that align with the upper line of meta carpel to be able to reflect the skin backwards.
The Laminectomy
The dissection starts by exposing the erector spinae muscle on the two sides of the spinous processes. First, we palpate though the spinal process right down the midline of the back. Then a horizontal cut is made in the middle of erector spinae muscle to reflect them back be able to better see spinal processes. The bony area of the vertebra lamina should be muscle clean and clear in order to break through it. Hammer and chisel is used to break through the lamina. We angle the chisel at 45 degree pointing toward the lamina of the vertebrae and tap the chisel with the hammer subtle consecutive taps. We start from about the level of inferior attachment of the splenius to the mid lumbar vertebrae. After dapping along the mentioned distance, the vertebrae transvers is now removed and spinal cord in now visible. The layer surrounding the spinal cord is called the dura mater. Using scissors, we cut through the dura mater to get a better view of the spinal cord.