Modified exposure for pronator syndrome decompression: a preliminary experience

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Plastic Surgery

Background:

• Hypertrophic and symptomatic scarring is a common complication of traditional lazy S incisions used for pronator tunnel release.
• The antecubital fossa is a sensitive area where scarring can significantly impact function and cosmesis.

Purpose of the Study:

• To introduce and evaluate a new surgical incision technique for pronator tunnel release.
• To minimize scarring and protect neurovascular structures in the antecubital fossa during pronator tunnel surgery.

Main Methods:

• A modified incision consisting of two offset linear incisions was developed.
• This approach allows visualization of the median nerve and brachial artery while preserving a skin bridge.
• Median nerve exposure involves splitting the pronator teres and fractional step cutting of the pronator aponeurosis.

Main Results:

• Preliminary experience in seven cases (five patients) showed encouraging outcomes.
• The modified incision provided adequate exposure of the median nerve and brachial artery.
• The intact skin bridge protected the medial cutaneous nerves of the arm and forearm.

Conclusions:

• The modified incision for pronator tunnel release is a promising alternative to traditional approaches.
• This technique may reduce the incidence of problematic scarring and protect critical neurovascular structures.
• Postoperative management with compressive wraps and elastomer inserts aids cosmetic healing.