this is Nicole deal in this video will 00:03 take you through my approach for many 00:05 open carpal tunnel release surgery you 00:09 see here we've drawn our incision in 00:10 line with the radial border of the ring 00:12 finger approximately one centimeter 00:13 distal to the wrist crease for the 00:16 purpose of illustration for the video 00:17 our incision is made larger than our 00:20 typical incision which is about a 00:21 centimeter in length the incision is 00:26 made through the skin 00:40 any superficial cutaneous vessels are 00:44 coagulated and then using blunt 00:48 dissection soft tissue is spread down to 00:53 the transverse carpal ligament using a 01:00 knife here we're just dissecting through 01:02 some of the palmar fascia down to the 01:04 transverse carpal ligament 01:16 the transverse carpal ligament is open 01:18 using the knife and then using 01:22 strabismus scissors is sharply 01:26 transected under under act visualization 01:31 here you can see the median nerve at the 01:34 base of the incision and trans section 01:39 of the transverse carpal ligament 01:40 approximately at the wrist 02:04 once the transverse carpal ligament is 02:06 completely transected the median nerve 02:10 itself is inspected you can frequently 02:12 see increased vascularity of the nerve 02:14 as you do here in this median nerve with 02:20 a vascular stripe along the epineurium 02:26 the wound is then irrigated and the 02:30 incision closed using an absorbable 02:32 suture 02:50 postoperatively the patient begins 02:52 immediate range of motion and a soft 02:59 dressing is applied during in the 03:01 operating room