Wrist – Volar Approach

Wrist – volar approach

* position – supine with tourniquet

* incision
– on ulnar side of thenar crease about 1/3 into hand
– curve prox. but stay out of thenar crease
– curve toward ulnar side of hand at flexion crease
– stay ulnar side of PL to preserve palmar cut. branch of median n.

* no internervous plane

* dissection
– incise skin flaps
– watch for palmar cut. branch of median n. – usu on ulnar side of FCR
– incise superficial palmar fascia in line with incision
– expose insertion of PL into flexor retinaculum
– retract PL ulnarly
– identify median n. btw tendons of PL & FCR
– incise retinaculum on ulnar side of median n. to protect motor branch
– motor branch of median n. – arises from anterolat. side of median n. as it emerges from carpal tunnel
– retract median n. radially
– retract tendons
– incise base of tunnel to expose carpus

* dangers
– palmar cut. branch of median n.
> arises 5cm prox. to wrist joint
> runs along ulnar side of FCR b4 crossing flexor retinaculum

– motor branch of median n.
> variable anatomy
> incise CT on ulnar side of median n.

– superficial palmar arch
> crosses palm at level of distal end of outstretched thumb
> blind slitting of flexor retinaculum may damage this arcade if split too far distally

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