If it is an exertional myopathy, a biopsy of the semitendinosus muscle using open surgical technique or a biopsy of the gluteal muscle using a needle biopsy instrument provides the best information. Biopsy Technique Using subcutaneous lidocaine, a 2 inch incision is made over the semitendinosus or membranosus muscle. Two parallel incisions in the muscle inch deep and inch apart are made. Transect the muscle dorsally and grasp with forceps freeing the deeper muscle tissue and finally transect ventrally. The sample should be at least the size of the last digit of your middle finger with the long axis paralleling the muscle fiber length and the short axis transecting the muscle fibers.
Intradermal sutures appear to be the best way to avoid dehiscence.
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