Table 2.

Surgical Pearls and Pitfalls

Pearls	Pitfalls
Electromyographic evaluation must be obtained prior to the procedure to exclude spinal or peripheral nerve pathology that may affect gluteal muscle function.	Failure to appreciate muscle atrophy related to spine or peripheral nerve pathology may result in transferring weak or nonviable gluteal maximus muscle.
Perioperative administration of tranexamic acid reduces intraoperative blood loss and risk of postoperative hematoma.	An attempt to perform transfer through minimally invasive approaches makes flap division and tensioning inconsistent and technically challenging.
Packing a laparotomy sponge posterior to the greater trochanter during exposure protects the sciatic nerve and safely divides adhesions from areas of chronic inflammation or prior surgical exposure.	Failure to protect the sciatic nerve during Charnley retractor placement or bone tunnel drilling may result in neurapraxia or direct injury to the nerve.
Splitting the proximal vastus lateralis allows appropriate placement of the distal row and provides a cuff of tissue for repair over the distal aspect of the tendon transfer.	Failure to abduct the leg on a Mayo stand during graft tensioning may result in inadvertent laxity of the muscle transfer.
The addition of the distal row likely allows excellent compression across the footprint and improves repair strength.	No biomechanical or outcome data on this specific mechanism of repair are available yet.