The Marsh Modification for Groin Reconstruction

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Presentation transcript:

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

New and Improved Rehabilitation Anaesthesia and pain control Surgical technique

Traditional 4 week program 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

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

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

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

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

Sport specific training Stage 4 Sport specific training

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

Accurate Ultrasound Guided Ilioinguinal nerve block

Pubic bone Stress Injury Aka: Osteitis Pubis

Graph of wound strength against time Wound without sutures Graph of wound strength against time

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

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

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

Groin Reconstruction Traditional repair Marsh Modification Based on established anatomical and physiological principles 30 years experience Established success 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

http://www.108harleystreet.co.uk/