Inguinal Lymph node dissection

1.Position the patient supine with the thigh mildly abducted and externally rotated.
2.Make a vertical lazy S (mirror S on left side starting at the ASIS) incision in the groin.
3.Raise flaps on a plane at the level of Scarpa’s fascia extending 5cm above the inguinal ligament, down to the lower part of the femoral triangle and from pubic tubercle to ASIS.
4.Incise the fat superiorly down to the external oblique and dissecting it off the muscle to the inguinal ligament.
5.Similarly incise the fat long the medial border of adductor longus and continue this dissection down to the apex of the femoral triangle.
6.Identify and ligate the saphenous vein and dissect the fat off the medial border of sartorius to the ASIS.
7.Dissect the specimen off the femoral vessels (and nerve laterally) starting medially towards the femoral vein as there are no tributaries on this side. Identify and ligate the SFJ.
8.Detach the sartorius origin and transpose it over the femoral vessels securing it to the inguinal ligament with 3/0 vicryl.
9.Lavage, drain and close, having administered LA via the drain tube.

Post op:
•Immobolise/ RIB for 2-3days
•Mobilise for short distances with leg elevated
•DVT prop
•Elastic stockings
Cx:
•Wound breakdown
•Skin necrosis and vessels on view
•Lymph fistula
•DVT
•Lymphodema
•Seroma
•Infection