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this is Rashard dick is discussing today
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of release of the first dorsal
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compartment or dequervain's flexor Tina
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Tina Center Vitus here we're making an
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oblique drawing here and on an oblique
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incision just distal to the radial
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styloid the skin is divided the
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substance issues are then elevated here
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you can see the local anesthetic as this
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is done under a Mac that section is in
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made in a longitudinal type fashion to
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attempt to identify the sensory nerves
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as we get deeper ya retinaculum of the
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first dorsal compartment will be
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identified again here sensory nerves are
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identified here with the goal being
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protection of these nerves throughout
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the procedure the retinaculum for the
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first dorsal compartment is now
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confirmed this is further confirmed by
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visualizing the tendons distally and
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then making our incision heading
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approximately care is taken to release
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the retinaculum on the dorsal most edge
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of the retinaculum to eliminate
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bowstring as a potential complication
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here distally the retinaculum is
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released the compartment is then
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released approximately after completion
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of the distal release and at that point
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we visualized only the APL tendon given
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this my goal was to identify the EPB
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which appears to be in a separate sheath
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the EPB is now released and released
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further distally
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this now confirms release of both
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tendons and the EPB here is visualized
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and removed which now shows the brachial
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radialis which is the floor of this
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compartment the APL is now assessed in
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multiple slips of the APL are identified
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and now confirmation that the sensory
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nerve was protected throughout the case
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is obtained the wrist is then flexed and
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extended again to ensure that there's no
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obvious bow straining of the tendons the
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wound is in irrigated skin is closed
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using a 300 micro type suture usually
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one to two sutures are all that is
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needed
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three-oh prolene is in utilized in at
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running so particular type fashion when
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the subcutaneous tissue is closed
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care was taken throughout to ensure that
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the nerve was not incorporated in the
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closure again we start our suture
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outside of the wound and we'll extend it
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sub particularly and then again place it
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outside of the incision for easy removal
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at the time of clinic follow-up patient
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is in place in a thumb Spica splint slim
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is maintained until follow-up visit
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which time patient will initiate
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occupational therapy