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
Identification median nerve, thenar motor branch and flexor tendons
- Visualization and inspection of the median nerve and optionally of the motor branch at the thenar eminence
- Description of the texture of the nerve regarding signs of compression (flattening, color, pseudoneuroma)
- Visualization and inspection of the flexor tendons, optional tenosynovectomy in cases of advanced chronic tenosynovitis
Advice:
- In case of mayor tenosynovitis, the incision should be extended proximally and ulnar to be able to perform a complete synovectomy.
Digital test carpal tunnel
Irrigation, closure wound
Irrigation, if necessary, drainage insertion and skin suture
- Careful irrigation of the surgical site with e.g., physiological Ringer's solution with final inspection
- If necessary, insert Mini-Redon- or Redon-Drain Ch 8
- Everting skin suture (single button/continuous/intracutaneous, Omni or steristrips if necessary)
- Sterile dressing, elastic compressive bandage
- If necessary, dorsal wrist splint
date of publication: 25.04.2009
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