Letournel and Judet ilioinguinal approach. A, Skin incision. B, Origins of abdominal and iliacus muscles have been elevated from iliac crest. Broken line shows incision through superficial fascia and external oblique aponeurosis. C, Lateral femoral cutaneous nerve has been exposed, and aponeurosis of external oblique has been incised. Iliacus has been reflected from inner table of ilium. Inguinal canal has been opened by reflecting incised flap of external oblique aponeurosis distally. Internal oblique, inguinal ligament, and spermatic cord or round ligament have been exposed. D, Inguinal ligament has been incised, releasing common origin of internal oblique and transversus abdominis muscles. E, Iliopectineal fascia separates lacuna musculorum and lacuna vasorum. F, Iliopectineal fascia is incised toward pectineal eminence. G, Internal iliac vessels have been separated and retracted medially from iliopectineal fascia. H, Three regions of pelvis exposed during approach. I, Lateral femoral cutaneous nerve, iliopsoas, and femoral nerve have been retracted medially to expose internal iliac fossa. J, Pelvic brim and pectineal eminence have been exposed by lateral retraction of iliopsoas and femoral nerve and medial retraction of external iliac vessels. K, Medial aspect of superior pubic ramus and pubic symphysis have been exposed by release of rectus abdominis and lateral retraction of external iliac vessels and spermatic cord or round ligament. SEE TECHNIQUE 1.77.