Pelvic Osteotomies for Cloacal Exstrophy

1. Exposure

1. Salter Incision: One finger width 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
4. Split Iliac Crest Apophysis

2. Osteotomy

1. Expose Inner & Outer Table of Ilium: Sub-periosteal dissection on medial and lateral surface
2. Expose Sciatic Notch
3. Cut from Crest to Sciatic Notch

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

4. Repeat previous steps for opposite side