Forearm – Dorsal Approach (Thompson)

Forearm – dorsal approach (Thompson)

* position – supine with tourniquet

* incision – straight incision from just anterior to lat. epicondyle –> ulnar side of Lister’s tubercle

* internervous plane:
– prox – ECRB (radial n.) & EDC (PIN)
– distal – ECRB (radial n.) & EPL (PIN)

* superficial dissection
– incise fascia
– interval btw ECRB & EDC
– start midshaft
– interval btw ECRB & EPL

* deep dissection
– proximal 1/3
> identify supinator
> locate PIN as it emerges 1 cm from distal end of muscle btw deep & superficial heads
> dissect nerve out of supinator
> fully supinate forearm
> detach supinator at insertion from ant. aspect of radius

– middle 1/3
> APL & EPB cross dorsal aspect of radius
> retract off bone & make incision along their sup. & inf. borders

– distal 1/3
> separating ECRB & EPL exposes lat. border of radius

* dangers – PIN – identify carefully b/c in 25% it touches the dorsal aspect of radius at level of biceps tuberosity