Intraoperative femoral head vascularity assessment: An innovative and simple technique (Letter 1).

Sir,

We read with interest the article on an innovative technique for assessing the vascularity of femoral head by Madhuri et al.1 I would like to congratulate the authors for describing this easy to use, and cost-effective technique. However, certain points require a little more elaboration, such as the surgical approach, patient positioning, procedure and type of dislocation used in the eight pediatric hips.

Also, I would like to know if we can use this technique via a transtrochanteric approach in the femoral head, without actually dislocating the hip. Although arterial pulsations are seen synchronous with the QRS complex of the ECG, they cannot be measured or standardized as is possible with laser Doppler flowmetry.2

A practical application of this study is in cases of avascular necrosis (AVN) which are being treated with vascular/nonvascular fibular grafting during followup to assess revascularization, but for this the technique requires modification for easy reproducibility and minimal invasiveness.

The 2 months of followup for three of the cases may not be enough to comment on the vascularity of head if no postoperative bone scan or MRI was done, even if per-operative wave forms were assessed.13