Division of Hand Surgery, Rothman Orthopaedics, Philadelphia, PA.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
J Hand Surg Am. 2023 Jun;48(6):622.e1-622.e7. doi: 10.1016/j.jhsa.2021.12.012. Epub 2022 Feb 25.
Cubital tunnel syndrome is the second most common upper-extremity compressive neuropathy, and persistent symptoms can necessitate operative treatment. Surgical options include simple decompression and ulnar nerve transposition. The cause of wound dehiscence after surgery is not well known, and the factors leading to the development of these complications have not been previously described.
Patients undergoing ulnar nerve surgery from January 1, 2016, to December 31, 2019, were retrospectively evaluated for the development of wound dehiscence within 3 months of surgery. There were 295 patients identified who underwent transposition and 1,106 patients who underwent simple decompression. Patient demographics and past medical history were collected to evaluate the risk factors for the development of wound dehiscence.
The overall rate of wound dehiscence following surgery was 2.5%. In the simple decompression group, the rate of wound dehiscence was 2.7% (30/1,106), which occurred a mean of 21 days (range, 2-57 days) following surgery. In the transposition group, the rate of wound dehiscence was 1.7% (5/295), which occurred a mean of 20 days (range, 12-32 days) following surgery. The difference in rates of dehiscence between the decompression and transposition groups was not significant. Five patients in the simple decompression group and 1 patient in the transposition group required a secondary surgery for closure of the wound. Age, body mass index, smoking status, and medical comorbidities were not found to contribute to the development of wound dehiscence.
Wound dehiscence can occur following both simple decompression and transposition, even after postoperative evaluation demonstrates a healed wound. Surgeons should be aware of this possibility and specifically counsel patients about remaining cautious with, and protective of, their wound for several weeks after surgery. Dehiscence may be related to suboptimal vascularity in the soft tissue envelope in the posteromedial elbow. When it occurs, dehiscence can generally be treated by allowing healing by secondary intention.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
肘管综合征是第二常见的上肢压迫性神经病，持续性症状可能需要手术治疗。手术选择包括单纯减压和尺神经转位。手术切口裂开的原因尚不清楚，以前也没有描述过导致这些并发症发展的因素。
对 2016 年 1 月 1 日至 2019 年 12 月 31 日期间接受尺神经手术的患者进行回顾性评估，以了解术后 3 个月内手术切口裂开的发生情况。共确定 295 例行转位术和 1106 例行单纯减压术的患者。收集患者的人口统计学和既往病史资料，以评估发生手术切口裂开的危险因素。
术后手术切口裂开的总体发生率为 2.5%。在单纯减压组中，手术切口裂开的发生率为 2.7%（30/1106），平均发生在术后 21 天（范围，2-57 天）。在转位组中，手术切口裂开的发生率为 1.7%（5/295），平均发生在术后 20 天（范围，12-32 天）。减压组和转位组的切口裂开率差异无统计学意义。单纯减压组中有 5 例患者和转位组中有 1 例患者需要再次手术缝合伤口。年龄、体重指数、吸烟状况和合并症均未发现与切口裂开的发生有关。
即使术后评估显示切口愈合，单纯减压和转位后仍可能发生手术切口裂开。外科医生应意识到这种可能性，并特别告知患者在手术后数周内仍要小心保护伤口。裂开可能与肘后内侧软组织包膜的血管化不足有关。当发生这种情况时，通常可以通过二期愈合来治疗裂开。
类型的研究/证据水平：治疗性 IV 级。
