Operative approaches: Forearm

Volar approach to the Radius (Henrys)

  • In an appropriately marked and consented, anaesthetised patient. I would complete the WHO checklist.
  • Set up: Supine, II available, arm board, exangunated, Torniquette to 250mmHg
  • Internervous plane: Radial nerve and median nerve
  • Incision variable length along line lateral to biceps tendon to radial styloid
  • Superficial dissection: Plane between brachioradialis and flexor carpi radialis. Move proximally to develop a plane between pronator teres and brachioradialis. ID the superficial radial nerve beneath the Bradioradialis.
  • Deep dissection: Follow the biceps tendon to its insertion. Radial to its insertion incise the bursa to aceess the proximal part of the radial artery.
  • supinate the forearm to displace the PIN radially and bring the origin of the supinator muscle. 

Volar approach to the Radius (Henrys)

  • In an appropriately marked and consented, anaesthetised patient. I would complete the WHO checklist.
  • Set up: Supine, II available, arm board, exangunated, Torniquette to 250mmHg
  • Internervous plane: Radial nerve and median nerve
  • Incision: Along a line between the radial styloid to lateral border of biceps tendon
  • Superficial dissection: Plane between the brachioradialis and flexor carpi radialis
  • Deep dissection: Pronate the arm to ID origin of the pronator teres detach the insertion and retract medially. 

Flexor Carpi Radialis approach

In an appropriately marked and consented, anaesthetised patient. I would complete the WHO checklist.

  • Set up: Patient supine on the table, arm board, II present, exsanguinate arm, torniquette 250mmHg.
  • Incision: 8cm over Flexor carpi radialis tendon to distal wrist crease.
  • Superficial dissection: Skin and subcut fat FCR ulnarly
  • Deep dissection: Flexor policis longus ulnar retraction. J shaped incision into pronator quatratus (radial and distal border of PQ). Periosteal elevator 
  • Internervous plane: AIN/Median
  • Risks: Radial nerve, palmar cutaenous nerve (5cm proximal from distal wrist crease ulnar to FCR)