A 24-year-old man was referred for muscle biopsy (see muscle biopsy discussion) after two episodes of exercise related rhabdomyolysis presenting as myoglobinuria and elevated creatinine kinase. There was no other significant history, physical or laboratory abnormality. Family history was significant for a father and grandfather who both died of acute renal failure while in their 30s. The left vastus lateralis (see thigh anatomy) was chosen as the biopsy site. Clamps and solutions were obtained from the Armed Forces Institute of Pathology (AFIP) as per protocol. The length of incision is shown.
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A 50/50 mixture of 1% lidocaine and 1/4% Marcaine without epinephrine was injected intradermally along the incision line. The stretch of the epidermal injection confers immediate skin anesthesia even before the chemical effect.
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