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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 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 Rehabilitation 4 Stages: Summary: Stage 1: Stage 2: Stage 3: Stage 4: Mobility Flexibility Strength 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 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 Wound with Dissolvable sutures Wound without 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 – 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/