00:01 this is Rashard dick is discussing today 00:04 of release of the first dorsal 00:05 compartment or dequervain's flexor Tina 00:08 Tina Center Vitus here we're making an 00:10 oblique drawing here and on an oblique 00:13 incision just distal to the radial 00:15 styloid the skin is divided the 00:19 substance issues are then elevated here 00:23 you can see the local anesthetic as this 00:26 is done under a Mac that section is in 00:30 made in a longitudinal type fashion to 00:32 attempt to identify the sensory nerves 00:38 as we get deeper ya retinaculum of the 00:42 first dorsal compartment will be 00:45 identified again here sensory nerves are 00:48 identified here with the goal being 00:51 protection of these nerves throughout 00:52 the procedure the retinaculum for the 01:02 first dorsal compartment is now 01:03 confirmed this is further confirmed by 01:06 visualizing the tendons distally and 01:08 then making our incision heading 01:10 approximately care is taken to release 01:14 the retinaculum on the dorsal most edge 01:17 of the retinaculum to eliminate 01:19 bowstring as a potential complication 01:22 here distally the retinaculum is 01:25 released the compartment is then 01:31 released approximately after completion 01:35 of the distal release and at that point 01:39 we visualized only the APL tendon given 01:43 this my goal was to identify the EPB 01:45 which appears to be in a separate sheath 01:48 the EPB is now released and released 01:53 further distally 02:00 this now confirms release of both 02:03 tendons and the EPB here is visualized 02:08 and removed which now shows the brachial 02:11 radialis which is the floor of this 02:12 compartment the APL is now assessed in 02:17 multiple slips of the APL are identified 02:21 and now confirmation that the sensory 02:27 nerve was protected throughout the case 02:30 is obtained the wrist is then flexed and 02:35 extended again to ensure that there's no 02:39 obvious bow straining of the tendons the 02:45 wound is in irrigated skin is closed 02:48 using a 300 micro type suture usually 02:53 one to two sutures are all that is 02:55 needed 02:58 three-oh prolene is in utilized in at 03:02 running so particular type fashion when 03:13 the subcutaneous tissue is closed 03:15 care was taken throughout to ensure that 03:16 the nerve was not incorporated in the 03:18 closure again we start our suture 03:25 outside of the wound and we'll extend it 03:30 sub particularly and then again place it 03:33 outside of the incision for easy removal 03:36 at the time of clinic follow-up patient 03:42 is in place in a thumb Spica splint slim 03:45 is maintained until follow-up visit 03:47 which time patient will initiate 03:49 occupational therapy