Revision carpal tunnel decompression and application of Polyganics Vivosorb membrane
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Revision carpal tunnel decompression and application of Polyganics Vivosorb membrane surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Revision carpal tunnel decompression and application of Polyganics Vivosorb membrane surgical procedure.
Carpal tunnel results from compression of the median nerve on the volar aspect of the wrist. Decompression is a successful operation when performed for the appropriate indication, when the nerve is completely released and when there is no impairment of nerve glide in the post-operative period.
Persistent carpal tunnel symptoms are associated with incomplete decompression and recurrent symptoms after an interval of 3 months or more are usually associated with a degree of scar formation causing further compression or resulting from nerve tether. The rate of failed primary carpal tunnel decompression is approximately 1:20. This figure includes those with significant persistent symptoms or new symptoms after surgery, incorrect diagnosis, contributing concomitant cervical radiculopathy and a failure to manage the patient’s expectations when there is severe nerve dysfunction. The rate of recurrent carpal tunnel syndrome requiring revision decompression within 10 years of the primary procedure is an additional 1:20. Recurrence rates are higher in diabetic patients due to nerve susceptibility to compression and a tendency to develop thickened chronic tenosynovium around the flexor tendons within the carpal canal. Recurrence is also common in women with low body mass index, possibly due to the decreased subcutaneous adipose tissue that otherwise fills the void left after flexor retinaculum (FR) release. The post operative healing in such cases includes rapid reforming of the FR which results in the recurrent compression. Patients with Hereditary Neuropathy with sensitivity to Pressure Palsies (HNPP), a genetic condition, are prone to multiple peripheral nerve compressions and recurrent compression after release. Patients with complications from primary surgery including infection may have impaired nerve glide and develop persistent or recurrent symptoms after primary release.
One of the causes of failed carpal tunnel decompression (CTD) is scarring of the median nerve paraneurium that impairs physiological nerve glide. Revision CTD may require the use of an adjunct barrier to prevent scar formation resulting in recurrent nerve tether. There are a number of biological and synthetic alternatives. The Vivosorb is a bioresorbable polymer layer that can be sutured loosely around a scarred nerve to prevent scar tether in the surgical bed, maintain nerve gliding and prevent recurrence of compression.
Readers will also find the following associated techniques of interest:
Author:Dominic Power MA MB BChir(Cantab) FRCSEd, FRCSLon, FRCS(Tr & Orth) Consultant Hand and Peripheral Nerve Surgeon Honorary Senior Clinical Lecturer, University of Birmingham, UK
Institution: West Midlands Peripheral Nerve Injury Service, Birmingham Hand Centre, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.