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This Concept Map, created with IHMC CmapTools, has information related to: Palmar Annular Ligament Desmotomy, Surgical Procedures such as Tenoscopic Approach: 1) A 2-cm skin incision is made that is centered between the proximal border of the PAL and the ergot on the palmar– plantar midline. 2) An arthroscope is inserted into the incision site entering distal to the annular ligament. 3) After which a cannula is then guided through the sheath from proximal to distal under arthroscopic control to ensure that it does not lie inside the manica flexoria. 4) The central obturator is then removed and a hook knife is introduced to incise the palmar annular ligament via the slot in the cannula. 5) This can be introduced from either a proximal or a distal direction, with the arthroscope in the opposite end to view the procedure. **This technique allows closed and accurate transection of the ligament without damaging other structures. **This method allows visual inspection of the entire sheath cavity and division of the annular ligament., Palmar Annular Ligament Desmotomy ???? Anatomy, Post-Op ???? Suture Removal (MO), Pre-Op ???? Intruments (MO), Surgical Procedures such as Blind Surgical Approach: 1) After surgical preparations, a 2-cm skin incision is made that is centered between the proximal border of the PAL and the ergot on the palmar– plantar midline. 2) Sharp dissection is continued through the subcutaneous tissue down to the transverse fibers of the PAL using a #15 blade. 3) Carefully dissect through the PAL until the division between the PAL and longitudinal fibers of the SDF tendon is identified through a 5-mm incision. 4) Curved Kelly forceps are directed through the incision in the PAL and tunneled under the distal half of the annular ligament to verify the dissection plane and serve as a guide for transection. 5) Kelly forceps are opened several millimeters, and a #15 blade is inserted between the jaws of the forceps with the cutting edge toward the annular ligament and advanced to incise the ligament. 6) The forceps may have to be repositioned once more further distally to complete the distal transection. 7)The forceps are then redirected proximally, and the proximal half is transected in the same manner to complete the PAL release. 8) In most cases, the attachment of the flexor sheath on either side of the midline can be seen in the surgical field. 9)By placing a finger into the skin incision and palpating the incised PAL, one can verify the complete release of the PAL. 10)The subcutaneous tissue is closed in a continuous pattern by using absorbable suture material, and the skin is closed by using nonabsorbable suture material in an interrupted pattern., Palmar Annular Ligament Desmotomy ???? Surgical Procedures, Palmar Annular Ligament Desmotomy ???? Pre-Op, Post-Op i Bandaging (MO), Palmar Annular Ligament Desmotomy ???? Post-Op, Post-Op ???? Exercise (MO), Post-Op includes Prognosis (MO), Pre-Op ???? Anaesthesia & Prep (MO), Palmar Annular Ligament Desmotomy ???? Complications & Indications, Palmar Annular Ligament Desmotomy ???? Advantages & Disadvantages (MO)