252
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
MAY, 1976
A Different Surgical Approach For Carpal Tunnel Syndrome* RAYMOND 0. PIERCE, M.D., Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
We present here a different surgical approach for the decompression of the median nerve in carpal tunnel syndrome. This approach provides excellent exposure and avoids hypertrophic scars in patients subject to keloid formation. The traditional S shaped incision or the transverse incision have their disadvantages." 2 The transverse incision does not allow visualization of the distal portion
Fig. 1. Surgical approach for carpal tunnel syndrome.
of the transverse ligament and the S shaped incision is apt to cause a hypertrophic scar. The present approach consists of a transverse incision at the wrist and a curved incision parallel to and on the ulnar side of the thenar crease (Fig. 1). *Read at the 79th Annual Convention of the National Medical Association New Orleans, Louisiana, August, 1974.
After the transverse incision is made, the skin and subcutaneous tissue are undermined, both proximally and distally. The proximal portion of the transverse carpal ligament and median nerve are identified. The transverse carpal ligament is then divided on the ulnar side of the median nerve, proceeding distally until obscured by the distal skin flap. The palmar skin incision is then made, leaving a bridge of skin of about one centimeter between the incisions. Subcutaneous tissue is dissected to the distal portion of the transverse carpal ligament. A hemostat is inserted ulnar to the median nerve under the transverse ligament from the proximal to the distal incision. The remaining transverse carpal ligament is then cut under direct vision. The motor branch of the median nerve can be explored and decompressed if necessary. The use of these two incisions for decompression of the median nerve avoids subsequent scar problems associated with the lazy-S incision in patients prone to keloid formation and provides better visualization of the median nerve than the transverse incision. LITERATURE CITED
1. BRUNER, J. M. Incisions for Plastic and Reconstructive (Non-Septic) Surgery of the Hand. Brit. J. Plastic Surgery, v. 4, p. 48, 1951. 2. BUNNELL, S. Plastic Problems in the Hand; Plastic Reconstructive Surgery, v. 1, p. 266, 1946.
(Cayler, from page 254)
help preserve your life and I hope that in so doing both both of us will live our lives with greater joy and happiness and with a larger concern for our fellow men." There is only one catch, and this may be a "Catch 22", if doing your job doesn't give you joy and more concern for the welfare of your fellow men, you must consider the possibility that the job as a physician may not be the correct and best position for you.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
MAY, 1976
A Different Surgical Approach For Carpal Tunnel Syndrome* RAYMOND 0. PIERCE, M.D., Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
We present here a different surgical approach for the decompression of the median nerve in carpal tunnel syndrome. This approach provides excellent exposure and avoids hypertrophic scars in patients subject to keloid formation. The traditional S shaped incision or the transverse incision have their disadvantages." 2 The transverse incision does not allow visualization of the distal portion
Fig. 1. Surgical approach for carpal tunnel syndrome.
of the transverse ligament and the S shaped incision is apt to cause a hypertrophic scar. The present approach consists of a transverse incision at the wrist and a curved incision parallel to and on the ulnar side of the thenar crease (Fig. 1). *Read at the 79th Annual Convention of the National Medical Association New Orleans, Louisiana, August, 1974.
After the transverse incision is made, the skin and subcutaneous tissue are undermined, both proximally and distally. The proximal portion of the transverse carpal ligament and median nerve are identified. The transverse carpal ligament is then divided on the ulnar side of the median nerve, proceeding distally until obscured by the distal skin flap. The palmar skin incision is then made, leaving a bridge of skin of about one centimeter between the incisions. Subcutaneous tissue is dissected to the distal portion of the transverse carpal ligament. A hemostat is inserted ulnar to the median nerve under the transverse ligament from the proximal to the distal incision. The remaining transverse carpal ligament is then cut under direct vision. The motor branch of the median nerve can be explored and decompressed if necessary. The use of these two incisions for decompression of the median nerve avoids subsequent scar problems associated with the lazy-S incision in patients prone to keloid formation and provides better visualization of the median nerve than the transverse incision. LITERATURE CITED
1. BRUNER, J. M. Incisions for Plastic and Reconstructive (Non-Septic) Surgery of the Hand. Brit. J. Plastic Surgery, v. 4, p. 48, 1951. 2. BUNNELL, S. Plastic Problems in the Hand; Plastic Reconstructive Surgery, v. 1, p. 266, 1946.
(Cayler, from page 254)
help preserve your life and I hope that in so doing both both of us will live our lives with greater joy and happiness and with a larger concern for our fellow men." There is only one catch, and this may be a "Catch 22", if doing your job doesn't give you joy and more concern for the welfare of your fellow men, you must consider the possibility that the job as a physician may not be the correct and best position for you.
