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The Marsh Modification for Groin Reconstruction Gilmore’s Groin updated Simon Marsh MA MD FRCS Eng FRCS Gen-Surg Surgical Director 108 Harley Street.

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Presentation on theme: "The Marsh Modification for Groin Reconstruction Gilmore’s Groin updated Simon Marsh MA MD FRCS Eng FRCS Gen-Surg Surgical Director 108 Harley Street."— Presentation transcript:

1 The Marsh Modification for Groin Reconstruction Gilmore’s Groin updated Simon Marsh MA MD FRCS Eng FRCS Gen-Surg Surgical Director 108 Harley Street

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4 New and Improved Rehabilitation Anaesthesia and pain control Surgical technique

5 Rehabilitation Traditional 4 week program Week 1:walk 4 x day Week 2:jog --- running adductor exercises Week 3: start sprinting cycling Week 4: kicking twist & turn Week 5: play PLAY

6 Rehabilitation 4 Stages: Summary: Stage 1:Mobility Stage 2:Flexibility Stage 3:Strength Stage 4:Sport Specific Different requirements for amateurs and professionals

7 Stage 1 Mobility Straight line activities Avoid abdominal straining Treadmill jogging/running Front crawl swimming Cross training

8 Stage 2 Flexibility Body weight movements Lunges Side lunges Partial squats Hip flexion and extension Begin ball work

9 Stage 3 Strength Increase intensity of core stability work Change of direction at speed Box drills Cutting drills Figure of eight routines

10 Stage 4 Sport specific training

11 Rehabilitation Professional: 3-4 weeks Amateur: 6-8 weeks

12 Accurate Ultrasound Guided Ilioinguinal nerve block

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14 Pubic bone Stress Injury Aka: Osteitis Pubis

15 Wound without sutures Graph of wound strength against time

16 Wound without sutures Graph of wound strength against time Wound with Dissolvable sutures

17 Wound without sutures Graph of wound strength against time Wound with Dissolvable sutures Wound with Permanent sutures

18 Surgical Technique Inguinal ligament tenolysis Plication of posterior wall Resuturing conjoint tendon to inguinal ligament 2/0 prolene darn (permanent) Closure of Scarpa’s fascia

19 Groin Reconstruction Marsh Modification –Builds on traditional repair –Incorporates the best from around the world –Includes inguinal ligament tenolysis and less tissue trauma –Specific anaesthesia –Individualised rehabilitation Traditional repair –Based on established anatomical and physiological principles –30 years experience –Established success

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