Abstract
ObjectiveUltrasound-guided thread release (USGTR) is a minimally invasive technique with excellent clinical outcomes currently used in clinical practice to divide the transverse carpal ligament in carpal tunnel syndrome. The purpose of this study is to determine whether this technique can be modified for use in large anatomical compartments in soft embalmed cadaveric models.Materials and methodsTwo operators adapted the USGTR technique for use in muscular compartments of the forearms and legs in a single soft embalmed cadaver. An iterative approach was used to adapt and improve the technique for use in large compartments, using equipment readily available in most radiology departments.ResultsThe USGTR technique was successfully modified and both operators were able to accurately divide fascial layers over distances of up to 30 cm using the modified technique. Fascial division was confirmed with ultrasound and dissection.ConclusionsThis adapted technique can successfully be used to divide fascial planes over longer distances than is currently achieved in clinical practice. The improved outcomes associated with USGTR at the carpal tunnel may therefore also be achievable in fasciotomy procedures in larger anatomical compartments. Further study is required to investigate the effects of this modified USGTR technique on intracompartmental pressure.
Highlights
Numerous anatomical compartments are confined by fibrous layers resulting in low compliance and fixed volume [1]
Using real-time ultrasound guidance, the blunt tunneling device was passed adjacent to the fascia for the required longitudinal distance, keeping the tip visualized throughout (Fig. 2)
Simulating raised intracompartmental pressure could not be achieved using this method. This is the first study investigating the feasibility of releasing large fascial compartments using a Ultrasound-guided thread release (USGTR) technique on a soft embalmed cadaveric model
Summary
Numerous anatomical compartments are confined by fibrous layers resulting in low compliance and fixed volume [1]. Processes increasing compartment volume, such as bleeding or edema, increase intracompartmental pressure, potentially compromising neurovascular structures. Less-invasive approaches have been developed aiming to maintain efficacy and reduce postoperative pain, improve patient satisfaction, and reduce recovery time vs open surgery [3, 4]. These include using Metzenbaum or endoscopic scissors via small skin incisions [5, 6] and ultrasoundguided meniscotome instruments [7]
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