Carpal tunnel syndrome - open carpal tunnel release - general and visceral surgery
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Plan/Incision
Anatomical orientation by palpating and drawing anatomical landmarks:
- Planning mini-incision with incision in the extension line mid-3rd/4th finger ray on ulnar attachment of the palmaris longus tendon at the aponeurosis (lead structure).
- Incision median palm about 2-3 cm long (mini-incision) starting about 1.0 to 1.5 cm distal to the
- Sharp transection of the subcutis under bipolar coagulation of individual
- Identification of the palmar aponeurosis
Advice:
- Identify the carpal tunnel via palpable os pisiforme and tuberculum scaphoidei
- The flexor retinaculum starts at the rascetta
- The median nerve is located between flexor carpi radialis tendons and palmaris longus tendon
Transection palmar aponeurosis
Transection flexor retinaculum
Section flexor retinaculum with palmar carpal lig
- Sharp transection of the distal part of the flexor retinaculum under vision
- The median nerve is identified
For a better view into the carpal tunnel, the surgeon should now move to the head end of the hand table.
- By careful blunt dissection with the scissors, the median nerve is released from the carpal roof
- The section of the retinaculum is completed towards proximally by scissor
- Section of the palmar carpal lig with the scissor at the ulnar side of the palmaris longus tendon (guiding structure)
Advice:
- Check with the scissor for complete section of the carpal tunnel
- Identify superficial palmar arterial arch to avoid damage
Identification median nerve and flexor tendons
Digital test carpal tunnel
Irrigation, closure wound
date of publication: 25.04.2009
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