Surgical Approach / Expose Cubital Tunnel

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As the distributor of this device, Integra does not practice medicine and does
not recommend this or any other surgical technique for use on a specific patient.
The surgeon who performs any implant procedure is responsible for determining
and using the appropriate techniques for implanting the device in each patient.

Surgical Approach Patient is placed supine on the operating table with the operative extremity placed on a hand table. Elevate the arm sufficiently to enhance access to the cubital tunnel. Identify and mark the medial epicondyle. Mark out an approximate 2cm incision over the cubital tunnel, posterior to the medial epicondyle (Figure 1a). Make an incision just through the dermis, placing the incision in the skin crease to minimize the scar.

Use scissors and forceps to dissect down to the deep fascia and medial epicondyle (Figure 1b). Protect any superficial nerves you encounter.

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Expose Cubital Tunnel Use scissors to elevate the subcutaneous tissue and create space between the deep fascia and the subcutaneous tissue/nerves proximally and distally. Retract the skin using standard retractors (Figure 2a).

Use the medial epicondyle for orientation and palpate the cubital tunnel and ulnar nerve. Lift the roof of the cubital tunnel with forceps and open the tunnel with a 15-blade. Identify and protect the ulnar nerve (Figure 2b).

Use scissors to open the cubital tunnel several centimeters. The Spatula may be used to facilitate access to the cubital tunnel and assist separating the ulnar nerve from the roof of the cubital tunnel (Figure 2c). Care should be taken to stay superficial to the nerve. The cubital tunnel must be opened sufficiently to allow atraumatic placement of the Cannula along the course of the ulnar nerve.

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