Complications of open carpal tunnel surgery: avoiding the pitfalls

We present a series of 31 patients treated for complications following open carpal tunnel syndrome surgery over a time period of 10 years. The most frequent complications encountered were major nerve lacerations at the wrist and thenar followed by persistent and recurrent symptoms, neuroma formation and wound infection. All patients had primary treatment by a different approach, by different spectrum of training surgeons; in only one patient, the initial operating surgeon was an orthopedic surgeon in hand fellowship training. In ten patients, the typical approach to the carpal tunnel has been used at the initial operation; an excessive ulnar-directed incision and a long proximal- and radial-directed incision have been observed in ten and eight patients, respectively; a mini-open incision and an incision that crossed the wrist perpendicular to the flexion creases have been observed in one and two patients, each. Most complications of open carpal tunnel surgery can be prevented by specialized training in hand surgery of the operative surgeon and proper operative technique, including a properly placed incision and exposure under magnification and direct vision.