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Double Fascial Flap Stabilization for Ulnar Nerve Instability After In Situ Decompression Shiro Yoshida, MD, PhD, Brent Trull, MD, Tsu-Min Tsai, MD Journal of Hand Surgery Global Online Volume 1, Issue 4, Pages 218-221 (October 2019) DOI: 10.1016/j.jhsg.2019.08.002 Copyright © 2019 The Authors Terms and Conditions

Figure 1 Posterior picture of left ulnar nerve release demonstrating medial translation of the nerve. The ulnar nerve is located just below the ruler and shows it breaking the sagittal plane of the most medial aspect of the medial epicondyle in the elbow flexion position: that is, the nerve is subluxing medial to the epicondyle. Because the subluxation is greater than 2 mm, this is grade 2 instability. The blue dot in this picture is the most medial–posterior aspect of the medial epicondyle. The white dot is the edge of the ulnar nerve. Journal of Hand Surgery Global Online 2019 1, 218-221DOI: (10.1016/j.jhsg.2019.08.002) Copyright © 2019 The Authors Terms and Conditions

Figure 2 A With the elbow flexed at 90°, an 8-cm incision is made over the ulnar nerve, centered over the cubital tunnel. B The double fascial flaps, shown as rectangles measuring 5 cm long and 2 cm wide, based on the medial epicondyle (M), are designed on the flexor carpal ulnaris fascia and the septum between triceps and biceps muscles. C The double flaps have been raised from the muscle and septum. D The flaps have been sutured to the medial side of the triceps fascia with the elbow in full flexion. The elevator showed enough loose tension of the double fascial flaps. Journal of Hand Surgery Global Online 2019 1, 218-221DOI: (10.1016/j.jhsg.2019.08.002) Copyright © 2019 The Authors Terms and Conditions