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Fascia wrapping technique: a modified method for the treatment of cubital tunnel syndrome.

Han HH, Kang HW, Lee JY, Jung SN - ScientificWorldJournal (2014)

Bottom Line: The preoperative mean value of motor conduction velocity (MCV) was 37.1 ± 6.7 m/s within the elbow segment and this result showed a decrease compared to the result of MCV with 53.9 ± 6.9 m/s in the below the elbow-wrist segment with statistical significance (P < 0.05).Postoperative mean values of MCV were improved in all of 20 patients to 47.6 ± 5.5 m/s (P < 0.05). 19 patients of 20 (95%) reported good or excellent clinical outcomes according to a modified Bishop scoring system.The wrapping method of anterior transposition is a newly designed alternative method modified from subfascial transposition.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.

ABSTRACT
Variations of the anterior transposition of the ulnar nerve for cubital tunnel syndrome include subcutaneous, submuscular, intramuscular, and subfascial methods. We introduce a modification of subfascial transposition, which is designed to facilitate nerve gliding by wrapping the nerve with fascia. Twenty patients with wrapping surgery following the diagnosis of cubital tunnel syndrome were reviewed retrospectively. Preoperative electrodiagnostic studies were performed in all patients and all of them were rechecked postoperatively. The preoperative mean value of motor conduction velocity (MCV) was 37.1 ± 6.7 m/s within the elbow segment and this result showed a decrease compared to the result of MCV with 53.9 ± 6.9 m/s in the below the elbow-wrist segment with statistical significance (P < 0.05). Postoperative mean values of MCV were improved in all of 20 patients to 47.6 ± 5.5 m/s (P < 0.05). 19 patients of 20 (95%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. The surgical treatment methods for cubital tunnel syndrome have their own advantages and disadvantages, and the preferred method differs depending on the surgeon. The wrapping method of anterior transposition is a newly designed alternative method modified from subfascial transposition. This method could be an alternative option to treat cubital tunnel syndrome.

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Schematic illustration of the wrapping procedures.
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fig3: Schematic illustration of the wrapping procedures.

Mentions: Skin and underlying subcutaneous tissues were curvilinear incised midway between the olecranon and medial epicondyle under general anesthesia and tourniquet control. The fascia was divided between the medial epicondyle and olecranon, passing proximally from the medial intermuscular septum to the postcondylar groove, releasing Osborne's band, which is an aponeurosis located between the two heads of flexor carpi ulnaris muscle. The feeding artery vessel of the nerve should be saved (Figure 1). An anterior transposition of the ulnar nerve was conducted followed by dissection to achieve a sufficient release without compression of the nerve (Figure 1). Superficial fascia belonging to the flexor pronator muscle group was elevated as a broad fascia flap with a width exceeding approximately 3 cm and a position of 1-2 cm apart from the medical epicondyle origin. Unlike the existing subfascial transposition, which is located in the nerve between muscle and fascia after elevating fascia flap, we conducted the wrapping procedure by locating the ulnar nerve over the fascia and very loosely rolling the ulnar nerve with the elevated fascia flap (Figures 2 and 3). The elevated fascia flap was firmly anchored onto the fascia located to the side of medial epicondyle through a continuous absorbable suture. The course of the transposed ulnar nerve was then rechecked to ensure that there was no kinking or compression. No drains were inserted for all patients.


Fascia wrapping technique: a modified method for the treatment of cubital tunnel syndrome.

Han HH, Kang HW, Lee JY, Jung SN - ScientificWorldJournal (2014)

Schematic illustration of the wrapping procedures.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4214043&req=5

fig3: Schematic illustration of the wrapping procedures.
Mentions: Skin and underlying subcutaneous tissues were curvilinear incised midway between the olecranon and medial epicondyle under general anesthesia and tourniquet control. The fascia was divided between the medial epicondyle and olecranon, passing proximally from the medial intermuscular septum to the postcondylar groove, releasing Osborne's band, which is an aponeurosis located between the two heads of flexor carpi ulnaris muscle. The feeding artery vessel of the nerve should be saved (Figure 1). An anterior transposition of the ulnar nerve was conducted followed by dissection to achieve a sufficient release without compression of the nerve (Figure 1). Superficial fascia belonging to the flexor pronator muscle group was elevated as a broad fascia flap with a width exceeding approximately 3 cm and a position of 1-2 cm apart from the medical epicondyle origin. Unlike the existing subfascial transposition, which is located in the nerve between muscle and fascia after elevating fascia flap, we conducted the wrapping procedure by locating the ulnar nerve over the fascia and very loosely rolling the ulnar nerve with the elevated fascia flap (Figures 2 and 3). The elevated fascia flap was firmly anchored onto the fascia located to the side of medial epicondyle through a continuous absorbable suture. The course of the transposed ulnar nerve was then rechecked to ensure that there was no kinking or compression. No drains were inserted for all patients.

Bottom Line: The preoperative mean value of motor conduction velocity (MCV) was 37.1 ± 6.7 m/s within the elbow segment and this result showed a decrease compared to the result of MCV with 53.9 ± 6.9 m/s in the below the elbow-wrist segment with statistical significance (P < 0.05).Postoperative mean values of MCV were improved in all of 20 patients to 47.6 ± 5.5 m/s (P < 0.05). 19 patients of 20 (95%) reported good or excellent clinical outcomes according to a modified Bishop scoring system.The wrapping method of anterior transposition is a newly designed alternative method modified from subfascial transposition.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.

ABSTRACT
Variations of the anterior transposition of the ulnar nerve for cubital tunnel syndrome include subcutaneous, submuscular, intramuscular, and subfascial methods. We introduce a modification of subfascial transposition, which is designed to facilitate nerve gliding by wrapping the nerve with fascia. Twenty patients with wrapping surgery following the diagnosis of cubital tunnel syndrome were reviewed retrospectively. Preoperative electrodiagnostic studies were performed in all patients and all of them were rechecked postoperatively. The preoperative mean value of motor conduction velocity (MCV) was 37.1 ± 6.7 m/s within the elbow segment and this result showed a decrease compared to the result of MCV with 53.9 ± 6.9 m/s in the below the elbow-wrist segment with statistical significance (P < 0.05). Postoperative mean values of MCV were improved in all of 20 patients to 47.6 ± 5.5 m/s (P < 0.05). 19 patients of 20 (95%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. The surgical treatment methods for cubital tunnel syndrome have their own advantages and disadvantages, and the preferred method differs depending on the surgeon. The wrapping method of anterior transposition is a newly designed alternative method modified from subfascial transposition. This method could be an alternative option to treat cubital tunnel syndrome.

Show MeSH
Related in: MedlinePlus