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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Lee, W. P. Andrew Schipper, Bret M. Goitz, Robert J. |
| Description | Country affiliation: United States Author Affiliation: Lee WP ( Division of Plastic Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA. Leewpa@upmc.edu) |
| Abstract | PURPOSE: This study evaluated the reliability and morbidity rate of carpal tunnel release with the Indiana Tome technique via a small palmar incision when used by experienced hand surgeons. METHODS: A retrospective review was performed of 1332 carpal tunnel releases using the Indiana Tome performed by 2 fellowship-trained hand surgeons at university hospitals from July 1993 to August 2006. Chart review focused on complications with this technique. RESULTS: All patients returned to preoperative activities, in employment or otherwise. Nonmanual laborers resumed regular job tasks between 2 days and 3 weeks. The 2 surgeons experienced 11 complications in 1332 cases, for an overall complication rate of 0.83%. The most common complication, in 8 cases, was numbness and hypersensitivity in the third common digital nerve distribution; 2 of these 8 patients had normal 2-point discrimination and the other 6 had persistently 2-point discrimination greater than 10 mm despite resolution of preoperative paresthesia symptoms. In the latter group, 3 patients had repeat exploration, with findings of fascicular injury and scarring in 2 patients and normal nerve in the third (who ultimately had normalized 2-point discrimination by 6 weeks after surgery). The 3 patients without re-exploration had their 2-point discrimination returned to normal by 11 months after surgery. Ultimately, only 2 patients (0.15%) had persistently increased 2-point discrimination. The remaining complications (3 cases) were transient neuropraxia of the entire median nerve (1 patient), an incomplete release (1 patient) requiring repeat surgery, and a recurrence of carpal tunnel syndrome (1 patient) with perineural scar noted at 8 months after surgery, treated successfully with a hypothenar fat pad flap. CONCLUSIONS: This is the largest retrospective review of the Indiana Tome technique to date. This technique can be used by experienced hand surgeons and offers early resumption of preoperative activities and a low complication rate. The most common complication was neurapraxia in the third common digital nerve distribution. The overall complication rate was 0.83% (11 in 1332). TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. |
| File Format | HTM / HTML |
| ISSN | 03635023 |
| Issue Number | 7 |
| Journal | The Journal of Hand Surgery |
| Volume Number | 33 |
| e-ISSN | 15316564 |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2008-09-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Surgery Carpal Tunnel Syndrome Surgery Ligaments, Articular Orthopedic Procedures Instrumentation Humans Retrospective Studies Journal Article |
| Content Type | Text |
| Resource Type | Article |
| Subject | Orthopedics and Sports Medicine Surgery |
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