THE MIDLINE POSTERIOR ELBOW INCISION - AN ANATOMICAL APPRAISAL

The formation of a painful neuroma after operations on the medial or l ateral sides of the elbow is a common problem. Our aim was to determin e the relationship of the cutaneous nerves to the three usual skin inc isions around the elbow,In 18 freshly frozen cadaver arms we made thre e standard 16 cm incisions in the skin medially, laterally, and poster iorly and explored them using loupe magnification. The number of nerve s crossing each incision was determined by gross observation and their diameter measured by electronic microcallipers. In ten arms, biopsies of the nerves in each incision were sent for histological examination , We found significantly more cutaneous nerves crossing the medial and lateral incisions than the posterior. The diameter of the nerves cros sing the posterior incision was significantly smaller than those cross ing the lateral incision. Cutaneous nerves are at considerable risk of injury when medial or lateral incisions are used to approach the elbo w, but the posterior approach carries less hazard. The routine use of the posterior incision may reduce the incidence of symptomatic paraest hesia and the formation of a painful neuroma after operation.