Purpose of the study: The aim of the study was to optimize, on the basis of an anatomical study, the technique of partial denervation of the wrist in terms of safety for preserving motor innervation of the quadrate pronator muscle, and to include this technique in the range of reconstruction operations for the treatment of degenerative carpal diseases.
Material and methods: The technique of partial denervation of the wrist, using excision of the sensitive branches of the dorsal and volar interosseous nerves, carried out by one-stage surgery from the dorsal approach is presented in a group of 28 patients. The partial denervation was always performed in addition to reconstructive surgery on the proximal carpals and the distal radioulnar joint. On the basis of an anatomical study involving 40 cadaverous upper extremities, the authors determined the location for resection of the sensitive branch of the volar interosseous nerve that is not associated with the risk of damaged motor innervation of the quadrate pronator muscle.
Results: A reliable identification of the motor branches of the volar interosseous nerve was achieved when an approximately 2-cm incision in the interosseous membrane was made 1 cm distal to the passing anterior branch of the interosseous artery that was clearly seen in the operating field. This corresponded to an incision in the skin, leading in the proximal direction at a length of about 7 cm, made 2 cm proximal to the distal radio-ulnar joint.
Discussion: The identification of motor branches is often difficult and therefore the authors recommend resection of the sensitive branch of the volar interosseous nerve to be performed in a safe zone that was determined by a large number of anatomical dissections. Partial denervation carried out according to the principles of a physiological procedure does not pose a burden for the patient and can markedly enhance the effect of reconstructive surgery.
Conclusion: Partial denervation of the wrist performed from the dorsal approach is a simple procedure easy to combine with other reconstructive operations on the wrist.