The palmar cutaneous branch of the median nerve and the approach to the carpal tunnel. An anatomical study.

As documented by dissection of twelve cadaver hands, the palmar cutaneous branch of the median nerve may be injured by a transverse incision at the wrist, while the terminal fibers of this branch, passing through the substance of the transverse carpal ligament on their way to the palmar skin, may be injured by longitudinal division of the ligament. To avoid such injury during decompression of the carpal tunnel, a curved longitudinal incision located on the ulnar side of the axis of the ring-finger ray and extending through the skin, subcutaneous tissue, and the ligament is recommended, followed by elevation of a radial flap keeping all three tissue layers and the palmar cutaneous branch intact.