Paul H. Wright, M.D., FRCSC
Clinical Associate Professor
U.B.C.
Burnaby, BC

Harvesting of the graft is often sited as the biggest challenge.  

Adequate Exposure:
Do not be afraid to make an incision large enough to visualize the graft and allow safe division of the Accessory bands. A 4 cm incision, placed well to the medial side ensures a safe harvest. Lift the leg off any bolsters to prevent the “ride up phenomena into the graft”. Leaving the graft attached distally and the use of an open harvester will allow for consistent traction.




Premature Division:
A short graft is usually the result of diversion of the stripper down the accessory bands to the Medial Head of the Gastrocne-mius Muscle. Visualize these and divide them with scissors under direct control before using the stripper.




Postoperative Pain Control:
After the graft has been sectioned, leave the harvester in place to use as a guide for local anaesthetic. Place the needle of your local as far proximal as possible, using the harvester as a guide for the needle tip. This permits instillation of local where it is needed. Femoral nerve blocks and local around and in the joint do not adequately block the Obturator Nerve. This simple technique will greatly reduce the postoperative pain in the hamstring region and allow for earlier range of motion.