MODIFIED EXPOSURE FOR PRONATOR SYNDROME DECOMPRESSION - A PRELIMINARYEXPERIENCE

Because hypertrophic and symptomatic scarring is not infrequent from a lazy S incision across the antecubital fossa, a new surgical approach to the pronator tunnel has been developed. Preliminary experience wit h this modified incision has proven to be encouraging in seven cases ( five patients). The exposure is composed of two off-set linear incisio ns which allow visualization of the median nerve and brachial artery d istal and proximal to the lacertus fibrosis. An intact bridge of skin at the antecubital fossa protects the medial cutaneous nerves of the a rm and forearm from injury. The median nerve is exposed by splitting t he pronator teres along its length, and fractional step cutting of the pronator aponeurosis relaxes the muscle. Postoperative scar managemen t with a compressive wrap and elastomer insert is helpful for cosmetic healing of the incisions.