1. Stephanie Valberg copyright Open Surgical Biopsy Semimembranosus Midpoint between tuber ischei and Achilles tendon

2. Stephanie Valberg copyright Open Surgical biopsy Lidocaine subcutaneously (10 ml) 2 inch vertical incision Incise skin, subcutaneous tissue Vertical incision through fascia

3. Stephanie Valberg copyright Open Surgical Biopsy Undermine the fascia on one side Make 2 parallel vertical incisions ½ inch apart

4. Stephanie Valberg copyright Open Surgical Biopsy - hold muscle in one place with forcep then transect dorsally -free biopsy ½” deep then transect ventrally

5. Stephanie Valberg copyright Open Surgical Biopsy 1” cube of muscle wrapped in saline moistened gauze, placed in a hard container and shipped overnight on icepacks1” cube of muscle wrapped in saline moistened gauze, placed in a hard container and shipped overnight on icepacks

6. Stephanie Valberg copyright Open Surgical Technique Close dead space with subcutaneous layers Close skin with intradermal sutures or staples Small scar

7. Stephanie Valberg copyright Histochemistry Muscle requires great care to freeze for histochemistry because; –Muscle is 80% water, 19 % protein, 1% glycogen –Ice crystals form readily in muscle cells placed in liquid nitrogen –This causes holes called freeze artifacts

8. Stephanie Valberg copyright Freezing Muscle biopsies Samples can be shipped to the lab chilled on ice packs within 24h Samples can be shipped frozen on dry ice and thawed in the lab, oriented and frozen in methylbutane, but this creates artifacts