A curved incision is made in the skin on the ulnar (little finger) side of the palm. It is made across the thenar (thumb crease) and along the long axis of the fourth (ring) finger from the lower border of the flexor retinaculum to the proximal wrist crease.
Surgical Details of the Procedure
1. The patient is placed supine (face up) on the operating room table. An upper arm tourniquet is applied and inflated.
2. The incision as above is made and the subcutaneous fat is carefully separated.
3. Inspection is made for the palmar cutaneous branch of the median nerve close to the palmaris longus and flexor pollicis longus at the thenar side of the median nerve.
4. The palmar fascia is then incised in a longitudinal fashion, starting at the proximal part of the incision.
5. This exposes the superficial transverse carpal ligament (aka antebrachial fascia).
6. The antebrachial fascia is then opened in a longitudinal fashion, starting at the proximal margin of the incision.
7. Close examination is made of the median nerve, which is dissected from along with its recurrent branch.
8. The epineurium is incised longitudinally with division of the volar carpal ligament.
9. The flexor retinaculum is then divided at the ulnar side (little finger) close to the hamate bone. Care must be taken to identify and avoid the motor branch of the recurrent nerve.
10. The wound is then closed at the skin only using an interrupted 4-0 or 5-0 nylon or a running 4-0 monocryl.
11. A volar plastic splint is applied for 2 weeks.
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