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.