Open Carpal Tunnel Release

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TECHNIQUE STEPS
 
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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

  • describe the steps verbally to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • Loupes recommended

2

Room setup and equipment

  • standard operative table with hand table

3

Patient positioning

  • supine position
G

Superficial Dissection

1

Mark the incision

  • mark the incision at the intersection of the Kaplan cardinal line and the radial border of the fourth ray ending at the wrist crease

2

Make incision

  • make incision anywhere along this mark
  • incision needs to be long enough that the proximal and distal aspects of the TCL can be visualized
H

Expose the TCL

1

Expose the TCL

  • use a scalpel or scissors to dissect through the subcutaneous fat and palmar tissue
  • the palmaris brevis muscle is often seen superficial to the TCL
  • incise and feather the palmaris brevis muscle from the TCL to allow adequate visualization
  • use a mosquito clamp or Carroll elevator into the carpal canal just deep to the TCL
  • this space defines the undersurface of the TCL and the hamate hook

2

Visualize the superficial surface of the TCL

  • place a right angle retractor
  • this is placed to protect the critical structures that are located between the skin and the ligament
I

TCL Release

1

Release the most ulnar aspect of the TCL

  • identify the most ulnar aspect of the TCL in the canal close to the hook of hamate
  • release the TCL under direct visualization
  • make sure to release proximally and distally
  • use scissors, scalpel or mini meniscotome type beaver blade
  • keep the radial leaflet of the TCL over the median nerve

2

Release the distal forearm fascia proximally

  • this is a common secondary site of compression

3

Confirm release of the TCL proximally and distally

J

Explore Median Nerve to Ensure Decompressed

1

Check nerve

  • check all areas for possible nerve compression before wound closure
K

Wound Closure

1

Superficial wound closure

  • use 3-0 nylon to close skin

2

Dressings

  • place in a soft dressing
Postoperative Patient Care
 

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