title: How to prevent injury to the palmar cutaneous branch of median nerve and ulnar nerve in a palmar incision in carpal tunnel release, a cadaveric study.
abstract: OBJECTIVE
  To identify palmar cutaneous branches of median nerve and ulnar nerve (PCBMN and PCBUN) and try to find a safe path at wrist and forearm in the decompression procedure of carpal tunnel syndrome.
  
  
  METHODS
  Ten formalin-fixed and five fresh-frozen cadaveric forearms were included in the study. The cross point of longitude of middle finger and distal wrist crease was defined as 0 point. Distal wrist crease (DWC) and 0 point were chosen as references for measurements. Several points on the pathway of PCBMN and PCBUN were measured.
  
  
  RESULTS
  The average distance between the origin of the PCBMN and PCBUN to the DWC was 4.95 ± 0.88 cm, 10.12 ± 1.50 cm, separately. The average distance between DWC and the point where PCBMN and PCBUN separated from their trunk was found to be 2.09 ± 0.31 cm, 2.90 ± 0.50 cm, separately. The distances between PCBMN, PCBUN and 0 point at DWC level was found to be 0.61 ± 0.12 cm, 0.47 ± 0.31 cm, separately. The diameters of two cutaneous branches were 0.10 ± 0.02 cm, 0.11 ± 0.04 cm, separately.
  
  
  CONCLUSIONS
  The general longitudinal palmar incision could avoid injuries to recurrent branch of median nerve and distal branches of palmar cutaneous nerve can be avoided macroscopically. The area about 5 mm ulnar and 6 mm radial to 0 point at wrist level was a relatively safe area.
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, No.12 Wulumuqi Zhong Road, Shanghai, China, 20040.
authors.forename: Xiuyue
authors.initials: X
authors.lastname: Xu
authors.forename: Jie
authors.initials: J
authors.lastname: Lao
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
mesh_terms: D002102:Cadaver; D002349:Carpal Tunnel Syndrome / Q000473:pathology* / Q000517:prevention & control; D019299:Decompression, Surgical / Q000379:methods; D005542:Forearm / Q000294:innervation / Q000473:pathology*; D006225:Hand / Q000294:innervation* / Q000473:pathology; D006801:Humans; D008475:Median Nerve / Q000293:injuries / Q000473:pathology*; D014459:Ulnar Nerve / Q000293:injuries / Q000473:pathology*