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    This document presents a new surgical approach for treating carpal tunnel syndrome that provides better exposure and avoids scarring issues. The approach uses two incisions: a transverse incision across the wrist and a curved incision parallel to the thenar crease. After the transverse incision, the skin and tissue are separated proximally and distally to expose the transverse carpal ligament and median nerve. The ligament is cut on the ulnar side of the nerve from proximal to distal. A second curved incision is then made, leaving a small bridge of skin between the incisions. Tissue is separated under the ligament to fully expose it, and it is cut under direct vision. This dual incision approach avoids sc

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    This document presents a new surgical approach for treating carpal tunnel syndrome that provides better exposure and avoids scarring issues. The approach uses two incisions: a transverse incision across the wrist and a curved incision parallel to the thenar crease. After the transverse incision, the skin and tissue are separated proximally and distally to expose the transverse carpal ligament and median nerve. The ligament is cut on the ulnar side of the nerve from proximal to distal. A second curved incision is then made, leaving a small bridge of skin between the incisions. Tissue is separated under the ligament to fully expose it, and it is cut under direct vision. This dual incision approach avoids sc

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    9 views1 page

    Jnma00475 0122

    Uploaded by

    carlos javier andraade
    This document presents a new surgical approach for treating carpal tunnel syndrome that provides better exposure and avoids scarring issues. The approach uses two incisions: a transverse incision across the wrist and a curved incision parallel to the thenar crease. After the transverse incision, the skin and tissue are separated proximally and distally to expose the transverse carpal ligament and median nerve. The ligament is cut on the ulnar side of the nerve from proximal to distal. A second curved incision is then made, leaving a small bridge of skin between the incisions. Tissue is separated under the ligament to fully expose it, and it is cut under direct vision. This dual incision approach avoids sc

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    of 1

    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 After the transverse incision is made, the skin and
    decompression of the median nerve in carpal tunnel subcutaneous tissue are undermined, both proximally
    syndrome. This approach provides excellent exposure and distally. The proximal portion of the transverse
    and avoids hypertrophic scars in patients subject to carpal ligament and median nerve are identified. The
    keloid formation. transverse carpal ligament is then divided on the ulnar
    The traditional S shaped incision or the transverse side of the median nerve, proceeding distally until ob-
    incision have their disadvantages." 2 The transverse in- scured by the distal skin flap. The palmar skin incision
    cision does not allow visualization of the distal portion 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 de-
    compressed if necessary.
    The use of these two incisions for decompression of
    the median nerve avoids subsequent scar problems as-
    sociated with the lazy-S incision in patients prone to
    Fig. 1. Surgical approach for carpal tunnel syndrome. keloid formation and provides better visualization of
    of the transverse ligament and the S shaped incision is the median nerve than the transverse incision.
    apt to cause a hypertrophic scar.
    The present approach consists of a transverse inci- LITERATURE CITED
    sion at the wrist and a curved incision parallel to and on 1. BRUNER, J. M. Incisions for Plastic and Recon-
    the ulnar side of the thenar crease (Fig. 1). structive (Non-Septic) Surgery of the Hand. Brit. J.
    Plastic Surgery, v. 4, p. 48, 1951.
    *Read at the 79th Annual Convention of the National Medical 2. BUNNELL, S. Plastic Problems in the Hand;
    Association New Orleans, Louisiana, August, 1974. 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
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    "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.

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