Sequelae of carpal tunnel surgery: rationale for the design of a surgical approach.

The sequelae of carpal tunnel surgery were reviewed and were presumed to be associated with the linear vertical section of the transverse carpal ligament because this was the common element in the reported series. The authors adopted a modified approach, substituting a parabolic incision that left a protective flap of the ligament to cover the structures within the tunnel in the area of maximum convexity of the wrist. The results from a recent series of 100 cases were contrasted with a control series of 770 previous cases. Untoward postoperative sequelae were significantly reduced through this modified approach. The improved results, the authors conclude, were attributable to a reduction of pressure within the carpal tunnel, while avoiding the wide gaping of the tunnel space that is associated with vertical incisions, which may allow an anterior displacement of the median nerve and flexor tendons between the cut ends of the transverse carpal ligament and sometimes result in a continuous scar through the skin.