Peer-review started: September 24, 2017
First decision: November 6, 2017
Revised: January 6, 2018
Accepted: January 23, 2018
Article in press: January 23, 2018
Published online: February 18, 2018
Processing time: 39 Days and 20 Hours
To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).
Twenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment (FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping (CASAM) to map the course of the nerves in each individual arm.
This image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.
CASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.
Core tip: Although many incision techniques can be found in literature no consensus on the best incision technique has been established. The study shows a large variation in the course of the superficial branch of the radial nerve over the first extensor compartment. However no complete safe zone can be defined. The choice of incision remains surgeons’ preference and surgical skills are paramount to prevent iatrogenic nerve damage.