Carpal tunnel syndrome: Carpal tunnel release - mini-open technique

Carpal tunnel syndrome (CTS) is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome, although certain indications would specifically indicate the need for surgery. Conservative management is typically preferred for transient cases of CTS such as those associated with pregnancy, short-term overuse or where other exacerbating phenomena are expected to be corrected. In other cases conservative management might be used for partial relief of symptoms while awaiting surgery or for diagnostic purposes in determining patient response [1].The surgical intervention for CTS is recommended in remaining case, in which is common to find out these characteristics: constant numbness, symptoms > 1 year durations, sensory loss, thenar weakness/atrophy. The first popularization of diagnosis and treatment of "carpal tunnel syndrome" is attributed to Phalen in 1950. Since then, there has been continued debate over the optimal management of this disease [2]. Currently, surgical options include these techniques: carpal tunnel release with a standard open, carpal tunnel release using various incision techniques (such as mini-open), endoscopic carpal tunnel release, open carpal tunnel release with additional procedures such as internal neurolysis, epineurotomy or tenosynovectomy. From August 2004 to November 2013, 780 procedures of carpal tunnel release using a mini open incision technique have been performed in our department. The procedure starts with an accurate skin detersion and disinfection. The intervention has been performed under local anesthesia and exsanguination with pneumatic tourniquet at the limb. The wrist extended approximately 30°. 2 cm long scalpel incision on Taleisnik line. Retraction of skin edges, incision of palmar aponeurosis, exposition and complete opening of flexor retinaculum to perform an external neurolysis of median nerve from fibro/adherential tissue. Before the wound closure a water dissection is performed to complete the procedure and to evaluate the decompression within the carpal tunnel. Postoperative bulky dressing and skin sutures are kept for 10 days and then removed. No complications like nerve, vascular or tendon damage, nor infection, relapse or failed treatment occurred. The one exception was a case of postoperative wound infection in a patient who dirtied the dressing during activities in a farm. In all cases patients referred a fast total regression of preoperatively symptoms. No painful and hypertrophic scars were observed.