the marsh modification for groin reconstruction gilmore’s groin updated simon marsh ma md frcs eng...
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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
New and Improved
• Rehabilitation
• Anaesthesia and pain control
• Surgical technique
RehabilitationRehabilitation
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
RehabilitationRehabilitation
4 Stages:
Summary:
Stage 1: MobilityStage 2: FlexibilityStage 3: StrengthStage 4: Sport Specific
Different requirements for amateurs and professionals
Stage 1Stage 1
Mobility
Straight line activitiesAvoid abdominal straining
Treadmill jogging/runningFront crawl swimmingCross training
Stage 2Stage 2
Flexibility
Body weight movements
LungesSide lungesPartial squatsHip flexion and extensionBegin ball work
Stage 3Stage 3
Strength
Increase intensity of core stability workChange of direction at speed
Box drills Cutting drillsFigure of eight routines
Stage 4Stage 4
Sport specific training
RehabilitationRehabilitation
Professional: 3-4 weeks
Amateur: 6-8 weeks
Accurate Ultrasound Accurate Ultrasound GuidedGuidedIlioinguinal nerve blockIlioinguinal nerve block
Pubic bone Stress InjuryPubic bone Stress Injury
Aka: Osteitis Pubis
Wound without sutures
Graph of wound strength against time
Wound without sutures
Graph of wound strength against time
Wound with
Dissolvable sutures
Wound without sutures
Graph of wound strength against time
Wound with
Dissolvable sutures
Wound withPermanent sutures
Surgical TechniqueSurgical 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 ReconstructionGroin 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
