Pelvic Osteotomies for Cloacal Exstrophy

1. Introduction

2. Exposure

1. Salter Incision
   • One fingerbreadth below iliac crest, 1–2 cm proximal to ASIS.
2. Elevate External Oblique Muscle
   • Iliac crest exposed from ASIS to 1/2–3/4 the length.
3. Dissect Sartorius/Tensor Fascia Lata Interval
   • Protect and medially reflect lateral femoral cutaneous nerve.
     

3. Osteotomy

1. Expose Inner and Outer Table of Ilium
   • Subperiosteal dissection on medial and lateral surface.
2. Expose Sciatic Notch
3. Cut from Crest to Sciatic Notch

4. Closure

• • Apply skin traction (Buck's traction).
  • May require osteotomy of ASIS to assist in closure.

5. Repeat for Opposite Side