Modified exposure for pronator syndrome decompression: a preliminary experience

Because hypertrophic and symptomatic scarring is not infrequent from a lazy S incision across the antecubital fossa, a new surgical approach to the pronator tunnel has been developed. Preliminary experience with this modified incision has proven to be encouraging in seven cases (five patients). The exposure is composed of two off-set linear incisions which allow visualization of the median nerve and brachial artery distal and proximal to the lacertus fibrosis. An intact bridge of skin at the antecubital fossa protects the medial cutaneous nerves of the arm and forearm from injury. The median nerve is exposed by splitting the pronator teres along its length, and fractional step cutting of the pronator aponeurosis relaxes the muscle. Postoperative scar management with a compressive wrap and elastomer insert is helpful for cosmetic healing of the incisions.