The ‘outside to inwards’ approach in the spaghetti wrist

Luke Geoghegan,Dariush Nikkhah

doi:10.1016/j.amsu.2020.05.047

Luke Geoghegan, Dariush Nikkhah

Open Access

https://doi.org/10.1016/j.amsu.2020.05.047

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Abstract

•The 'spaghetti wrist' is a complex injury pattern.•Emptying the forearm and carpal tunnel permits repair accurate repair of volar structures working from deep to superficial.•This pragmatic approach permits better anatomical appreciation and sequence of repair.

Highlights

Deep lacerations to the volar aspect of the distal forearm may result in a ‘spaghetti wrist’ pattern of injury with multiple lacerations to flexor tendons, nerves and vasculature
The repairs can be started from deep to superficial and as demonstrated the anatomy is better appreciated with this sequence of repair (Fig. 2)
Ethical approval was not required for this study

Summary

Background

Deep lacerations to the volar aspect of the distal forearm may result in a ‘spaghetti wrist’ pattern of injury with multiple lacerations to flexor tendons, nerves and vasculature. The term ‘spaghetti wrist’ was originally coined by Puckett and Meyer to describe a volar forearm laceration with three or more injured structures [1], and Koshy et al recently described a classification system based on the extent of injury [2]. Accurate repair is reliant on knowledge of anatomy and a systematic method of repair. This reduces risks of inadvertently repairing wrong structures and prolonged Tourniquet times

Technique

Ethical approval