Anatomical landmarks for safer carpal tunnel decompression: an experimental cadaveric study

Patient Safety in Surgery

Rohan W Jayasekara²  Dimonge J Anthony²  Ajith P Malalasekera²  Madusha Jayasekara²  Malith H Guruge²  Lasitha B Samarakoon¹ 

[1] General surgical unit, National Hospital Sri Lanka, Colombo, Sri Lanka;Department of Anatomy, Faculty of medicine, University of Colombo, Colombo, Sri Lanka

关键词: Avascular area;    Superficial palmar arch;    Palmar cutaneous branch;    Recurrent branch;    Transverse carpal ligament;    Carpal tunnel decompression;   

Others  :  790269
DOI  :  10.1186/1754-9493-8-8

 received in 2013-12-03, accepted in 2014-02-03,  发布年份 2014

【 摘 要 】

Background

Carpal tunnel syndrome is a common presentation to surgical outpatient clinics. Treatment of carpal tunnel syndrome involves surgical division of the flexor retinaculum. Palmar and recurrent branches of the median nerve as well as the superficial palmar arch are at risk of damage.

Methodology

Thirteen cadavers of Sri Lankan nationality were selected. Cadavers with deformed or damaged hands were excluded. All selected cadavers were preserved with the conventional arterial method using formalin as the main preservative. Both hands of the cadavers were placed in the anatomical position and dissected carefully. We took pre- determined measurements using a vernier caliper. We hypothesized that the structures at risk during carpal tunnel decompression such as recurrent branch of the median nerve and superficial palmar arch can be protected if simple anatomical landmarks are identified. We also hypothesized that an avascular area exists in the flexor retinaculum, identification of which facilitates safe dissection with minimal intra operative bleeding. Therefore we attempted to characterize the anatomical extent of such an avascular area as well as anatomical landmarks for a safer carpal tunnel decompression.

Ethical clearance was obtained for the study.

Results

In a majority of specimens the recurrent branch was a single trunk (n =20, 76.9%). Similarly 84.6% (n = 22) were extra ligamentous in location. Mean distance from the distal border of the TCL to the recurrent branch was 7.75 mm. Mean distance from the distal border of TCL to the superficial palmar arch was 11.48 mm. Mean length of the flexor retinaculum, as measured along the incision, was 27.00 mm. Mean proximal and distal width of the avascular area on TCL was 11.10 mm and 7.09 mm respectively.

Conclusion

We recommend incision along the radial border of the extended ring finger for carpal tunnel decompression. Extending the incision more than 8.16 mm proximally and 7.75 mm distally from the corresponding borders of the TCL should be avoided. Incision should be kept to a mean length of 27.0 mm, which corresponds to the length of TCL along the above axis. We also propose an avascular area along the TCL, identification of which minimizes blood loss.

【 授权许可】

   
2014 Samarakoon et al.; licensee BioMed Central Ltd.

【 图 表 】

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