ABSTRACT
Anteroposterior and lateral radiographs are used for templating to determine the necessary bone resection level, and clinical examination is vital to plan satisfactory soft tissue closure with skin that is sensate and that will heal normally. A priority is adequate blood supply to the soft tissues to enable this. Ideal and minimal resection levels should be taken into account. General anaesthesia is used, with the patient positioned supine. There is some evidence to suggest that epidural anaesthesia, local anaesthetic infiltration of the nerves prior to transection and good analgesia in the immediate postoperative period are effective in reducing the significant problem of postoperative neurological pain. The bone transection point is marked as per planning/templating. Equal anterior and posterior flaps are marked on the thigh, with their apices at the midpoint medially and laterally, at the level of anticipated bony transection. The quadriceps muscle is divided, straight down to bone, in the line of the incision.
