Rimini Hand and Upper Limb Surgery and Rehabilitation Center Hand Surgery.
Pro-Mano, Hand Surgery and Rehabilitation Hand Surgery.
Handchir Mikrochir Plast Chir. 2022 Apr;54(2):126-130. doi: 10.1055/a-1777-6694. Epub 2022 Apr 13.
Post-operative pain in the palm and scar area is the most common complication after carpal tunnel release and injury to the terminal branches of the palmar cutaneous nerve is generally considered one of the causes for this complication. The Authors performed an intraoperative study preserving the terminal branches of the palmar cutaneous branch of the median nerve and verifying the frequency, location and direction of the branches that cross an interthenar incision.
Eighty-five consecutive patients (57 F - 28 M, mean age 66 y) underwent carpal tunnel release between February and June 2021. The cutaneous branches crossing the incision were identified and preserved by careful dissection. Subsequently they were counted and classified by their direction and distance from the proximal border of the transverse carpal ligament.
Sensory branches were found in 40 % of cases (34/85) and their origin was observed at an average of 1.05 cm (0-1.8 cm) distal from the proximal border of the carpal tunnel. A total of 44 branches were observed of which 23 branches crossed the incision with a transverse course and 21 with an oblique, generally proximal-distal radio-ulnar course. The subcutaneous layer overlying the distal third of the transverse carpal ligament was found to be devoid of sensory branches, therefore it can be considered a relatively safe area.
Isolation and protection of palmar sensory branches is important for improving carpal tunnel release results. This goal can be more easily achieved by locating the skin incision on the distal third of the transverse carpal ligament, where the sensory branches have a lower frequency, possibly associated with a second proximal incision (biportal technique) to better visualize the proximal portion of the ligament and antebrachial fascia.
腕管松解术后手掌和疤痕区域的术后疼痛是最常见的并发症，而掌皮神经终末支的损伤通常被认为是这种并发症的原因之一。作者进行了一项术中研究，保留正中神经掌皮支的终末支，并验证了穿过间腕切口的分支的频率、位置和方向。
2021 年 2 月至 6 月，85 例连续患者（57 例女性-28 例男性，平均年龄 66 岁）接受了腕管松解术。通过仔细解剖识别和保留穿过切口的皮支。随后，根据它们与腕横韧带近端边界的距离和方向对其进行计数和分类。
在 40%的病例（34/85）中发现了感觉支，其起源于腕管近端边界 1.05cm（0-1.8cm）的平均距离处。共观察到 44 个分支，其中 23 个分支以横形穿过切口，21 个分支以斜形、通常为近-远桡侧走行穿过切口。在腕横韧带远端三分之一的皮下层发现没有感觉支，因此可以认为是一个相对安全的区域。
隔离和保护掌侧感觉支对于改善腕管松解术的结果很重要。通过将皮肤切口定位在腕横韧带的远端三分之一处，可以更容易地实现这一目标，在该处感觉支的频率较低，可能与第二个近端切口（双入口技术）相关，以更好地观察韧带和前臂筋膜的近端部分。
