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Subcutaneous Transposition of Ulnar Nerve

PREOPERATIVE DIAGNOSIS:
1. Right carpal tunnel syndrome.
2. Right cubital tunnel syndrome.

POSTOPERATIVE DIAGNOSIS:
1. Right carpal tunnel syndrome.
2. Right cubital tunnel syndrome.

OPERATIONS PERFORMED: Subcutaneous transposition of the right ulnar nerve.

ANESTHESIA: General

TOURNIQUET TIME: Forty minutes.

DESCRIPTION OF PROCEDURE: With the patient under adequate anesthesia, the upper extremity was prepped and draped in a sterile manner. The arm was exsanguinated. The tourniquet was elevated to 290 mm/Hg. An incision was made on the medial aspect of the arm and carried out anterior to the medial epicondyle across the antecubital fossa. Using blunt dissection, branches of the medial brachial, and antebrachial cutaneous nerves were dissected and retracted out of the operative field. Anterior flap was further dissected across the medial epicondyle anterior to the antebrachial fasciae. The medial intermuscular septum was then dissected from the arcade of Struthers to its insertion on the medial epicondyle and excised in toto. Care was taken to protect the underlying ulnar nerve. Ulnar nerve was then dissected from surrounding soft tissue with its vascular leash from the proximal incision to the level of the cubital tunnel. At the cubital tunnel, the interval between the heads of the flexor carpi ulnaris tendon were then incised longitudinally along the antebrachial fasciae. The ulnar nerve was then further dissected into the cubital tunnel to the level of the first motor branch. The nerve was freed from surrounding soft tissue with care taken to protect motor branch. The ulnar nerve was then transposed anterior to the medial epicondyle.

The elbow was put through full range of motion. No compression points or acute angles were identified. An Eaton sling was then fashioned from antebrachial fasciae and sutured to the anterior skin flap, using interrupted 3-0 Vicryl sutures. Again, the elbow was put through full motion and no compression points were identified.

The skin was allowed to resume its normal anatomical position, and closed in a layered fashion using 3-0 Vicryl subcutaneous stitches and running 3-0 Prolene subcuticular stitch. Sterile dressing were then applied to all wounds, over the sterile dressing a sugar-tong splint with the hand in sage position was then applied. The tourniquet was deflated. The patient was awakened from anesthesia and returned to the Recovery Room in satisfactory condition having tolerated the procedure well.

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