Preoperative

Special Equipment

• Basic tray

Operating Room Set-up

• Headlight
  
• Loupes

Anesthetic Issues

• Monitored anesthesia care in most cases; general anesthetic for uncooperative patients
  
• Perioperative antibiotics (first generation cephalosporin)
  
• Pad patient appropriately.

Miscellaneous

• Muscle biopsy may be useful in distinguishing a number of distinct pathologies, including muscular dystrophy, infection, mitochondrial myopathy, vasculitis, enzyme deficiency, malignancy, inflammatory myopathy, and other disorders.

• Chlorhexidine scrub of the biopsy area, followed by alcohol paint, followed by Betadine paint that is allowed to dry
  
• Split sheets and/or extremity drapes may be used to drape the surgical field.
  
• A 2- to 3-cm incision is marked overlying the target muscle.

Technique

• The incision is injected with local anesthetic (four parts lidocaine 0.5% with epinephrine, four parts bupivacaine 0.25%, one part sodium bicarbonate); do not inject the muscle itself as that may substantially degrade the quality of the tissue to be biopsied.
  
• Incise the skin with a no. 15 blade and place a self retaining retractor.
  
• Incise the fascia overlying the muscle in the direction of the muscle fibers.
  
• Use a curved Adson clamp to isolate a 2-cm bundle of muscle fibers, and sharply cut them free with scissors or a scalpel.
  
• Inject muscle belly with local anesthetic.
  
• Slice the specimen longitudinally into four pieces (different pathology departments may require additional pieces), place one drop of normal saline onto each piece (additional fluid may degrade biochemical analysis), place specimen container on ice for transport to the pathology department; avoid crushing the muscle fibers with instruments during this process.
  
• Irrigate the wound and close with 3-0 Vicryl suture and Steri-Strips.

Postoperative

• Place an ice pack on the wound in the recovery room, and continue intermittently for 24 hours to lessen postoperative pain.
  
• Patients may ambulate as soon as possible in the postoperative period.