Monday 23 March 2015

Carpal Tunnel Release Technique

Carpal tunnel release mr kamil's way:
1.generous akin incision... kaplan line till about 1cm below transverse crease at wrist... incision at 5mm ulna to palmar crease till trnsverse crease at wrist then do z shape
2.ada muscle jumpa before transverse carpal lig is palmaris brevis and can cut... no issue... n akan jumpa vessels branch to the muscle
3.use blade till jumpa transverse carpal ligament..
4.protect median nerve with mc donald, cut transverse carpal lig towards 2nd webspace... cut using blade
5.once nampak ada fatty tissue be careful for palmar arch... use scissors
6.proximal to transverse carpal lig, u can find antebrachial fascia... cut this fascia too
7.inspect the median nerve either it contused, compressed, constrict or pale or presint (dunno how to spell tp maksdnya looks normal n nice)
8. Track recurrent motor branch... tgk intact ke tak
9. Inspect samada ada any space occupying lesion in carpal tunnel... so kne korek smpi tendon2 tu
10.wash... secure bleeding...
11.suture with nylon 5/0 5mm distance n 5mm from skin edge
12.h2o2 dapped at wound
13.clean n dressing
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Post op plan:
Wi day 1
Then eod dressing
Tca 2weeks wound care n sto
Start nerve gliding exercise at day 1
Ask pt to buy carpal tunnel splint at pharmacy

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