Volar carpal exposure modified Henry approach

The modified Henry or trans-flexor carpi radialis (FCR) approach is a popular approach for exposure of the volar surface of the distal radius. Appropriate capsulotomies from the origins of the radiocarpal ligaments could also provide access to the radiocarpal joint, proximal scaphoid, and lunate.

Skin and subcutaneous tissue

A longitudinal incision over the FCR tendon is carried proximally for 3 to 4 cm. Care must be taken not to cross the ulnar border of the FCR tendon, because the palmar cutaneous branch of the median nerve lies there.

Deeper dissection

The FCR tendon sheath is divided longitudinally to expose the FCR tendon. Retraction of the FCR tendon will reveal the floor the FCR tendon sheath. Another longitudinal incision is made through the floor of the FCR tendon sheath and the underlying connective tissue. On the radial side of the FCR tendon sheath, the radial artery and its venae comitantes can be visualized. Care must be taken to protect this vascular structure. The pro-nator quadratus muscle will be encountered. An incision is made along its distal margin. Retraction of the FCR tendon and radial artery radially will

Ligament Sparing

Fig. 11. (A) Ligament-sparing capsulotomy for exposure of the ulnocarpal joint; line shows incision path. Care should be taken during this procedure not to injure the triangular fibrocartilage complex. (B) Completion of the ulnocarpal capsulotomy showing adequate dorsal exposure of the triangular fibrocartilage complex, proximal surfaces of the lunate and triquetrum, and the lunotriquetral joint. (A and B copyright 2006 Mayo Clinics, reproduced with permission of the Mayo Foundation.)

Fig. 11. (A) Ligament-sparing capsulotomy for exposure of the ulnocarpal joint; line shows incision path. Care should be taken during this procedure not to injure the triangular fibrocartilage complex. (B) Completion of the ulnocarpal capsulotomy showing adequate dorsal exposure of the triangular fibrocartilage complex, proximal surfaces of the lunate and triquetrum, and the lunotriquetral joint. (A and B copyright 2006 Mayo Clinics, reproduced with permission of the Mayo Foundation.)

Mayo Capsulotomy Wrist

Fig. 12. After the wrist has undergone its surgical procedure, closure is performed anatomically. The capsulotomy is closed by nonabsorbable sutures. Because there is no complete transaction of the dorsal carpal ligaments, there is no need for high-strength repairs. The extensor tendons are replaced and the extensor retinaculum is closed, transposing the extensor pollicus longus dorsal to the retinaculum. (Copyright 2006 Mayo Clinics, reproduced with permission of the Mayo Foundation.)

Fig. 12. After the wrist has undergone its surgical procedure, closure is performed anatomically. The capsulotomy is closed by nonabsorbable sutures. Because there is no complete transaction of the dorsal carpal ligaments, there is no need for high-strength repairs. The extensor tendons are replaced and the extensor retinaculum is closed, transposing the extensor pollicus longus dorsal to the retinaculum. (Copyright 2006 Mayo Clinics, reproduced with permission of the Mayo Foundation.)

expose the radial margin of the pronator quad-ratus muscle. An incision is made on the radial margin, leaving a 1 cm cuff of muscle on the radial side for later repair. The pronator quadratus muscle can now be elevated subperiosteally in a radial to ulnar direction to expose the volar surface of the distal radius and the volar radio-carpal wrist capsule. Self-retaining retractors can now be inserted into the wound, with the pronator quadratus muscle bulk on the ulnar side protecting the flexor tendons and median nerve, and the FCR tendon and radial artery on the radial side.

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