Universität zu Köln

Ayache, A., Unglaub, F., Langer, M. F., Mueller, L. P., Oppermann, J., Loew, S. and Spies, C. K. (2020). Surgical treatment of carpal tunnel syndrome: open release of the flexor retinaculum and hypothenar fat flap for revision surgery. Oper. Orthopade Traumatol., 32 (3). S. 219 - 236. MUNICH: URBAN & VOGEL. ISSN 1439-0981

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Abstract

Objective Decompression of the median nerve by complete release of the flexor retinaculum and the distal antebrachial fascia. In the case of revision surgery providing of a scar-free covering of the median nerve, if necessary. Indications Carpal tunnel release is indicated for symptomatic patients with painful paraesthesia or neurological deficits after adequate diagnostic evaluation. The hypothenar fat flap is indicated in revision surgery if a sufficient nerve bed of the median nerve is needed and to restore nerve gliding. Contraindications General operative limitations. The hypothenar fat flap is not indicated in revision surgery if median nerve irritation is not caused by surrounding scaring but other reasons like tendonitis. Surgical technique Proximal longitudinal incision of the palm. Subcutaneous dissection and incision of the palmar aponeurosis. Careful ulnar incision of the transverse carpal ligament. Considerate release of the distal and proximal parts of the retinaculum as well as the distal part of the antebrachial fascia. Exploration of the median nerve and palpation of the carpal tunnel and resection of compressive structures, if necessary. In case of revision surgery, if required, the hypothenar fat flap is raised. The fat flap is transposed without tension palmar to the median nerve and fixed to the radial side of the carpal tunnel. Postoperative management Early functional mobilization. Immobilization for a short period is optional. After revision surgery and hypothenar fat flap, splinting for one week is recommended.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ayache, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Unglaub, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Langer, M. F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, L. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Oppermann, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Loew, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Spies, C. K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-330247
DOI:	10.1007/s00064-020-00662-y
Journal or Publication Title:	Oper. Orthopade Traumatol.
Volume:	32
Number:	3
Page Range:	S. 219 - 236
Date:	2020
Publisher:	URBAN & VOGEL
Place of Publication:	MUNICH
ISSN:	1439-0981
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NERVE; DECOMPRESSION; COMPLICATIONS; REOPERATION; COMPRESSION; DIAGNOSIS Multiple languages Orthopedics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33024