Effectiveness and Safety in Closed Mini-Transverse Incision with Hydro-Dissection Technique in Carpal Tunnel Release: A Cadaveric Study

Abstract

Background: Closed mini-wrist transverse incision for carpal tunnel release has been reported in decreasing surgical scar problems, but there were few cadaveric studies that proved the effectiveness and safety in this technique without protective instrument to the median nerve. Hydro-dissection was previously showed to separate median nerve and deep structures during percutaneous ultrasound guided transverse carpal ligament release. This cadaveric study aims to demonstrated effectiveness and safety of closed transverse carpal ligament (TCL) release though the mini-transverse incision at distal wrist crease combined with hydrodissection technique. Neither special instrument nor retractor was used to protect neurovascular structures. Methods: Twelve fresh frozen cadaveric wrists were included in this study. Completeness of TCL release and injury to the adjacent neurovascular structures were assessed by direct visualization. Thickness of TCL, TCL length and distance from incision to adjacent neurovascular structures were also recorded. Results: Complete release of TCL was demonstrated in all 12 (100%) wrists underwent the mini-transverse incision TCL release at distal wrist crease and hydro-dissection technique. No injury to the adjacent neurovascular structures was found in all 12 wrists. Mean of thickness of TCL and TCL length were 3 mm and 28.7 mm, respectively. The ulnar artery was the nearest structure to the incision (mean = 3.7 mm). Conclusions: The closed mini-transverse incision TCL release at distal wrist crease with hydro-dissection technique demonstrated completeness of TCL division and safety to the neurovascular structures without protecting retractor or special instrument.