Anatomical variations of the median nerve and of the vascular-nervous structures at the wrist.

Three cases of anatomical variation of the median nerve at the wrist found during our surgical activity led us to take the opportunity to expose anatomical variations by reviewing already published reviews. Consequently, on the basis of anatomical studies, clinical reports and imaging, as a result of careful examination of the published literature, it has been observed that the interventions in such anatomical area must take into account these variations. In particular, the most performed procedure is the lysis of the transverse carpal ligament (TCL), which is not free from complications. In our opinion it is therefore necessary, in order to avoid the complications of the nervous, vascular and tendinous sections, to use some specific technical procedures.

[Office surgery. Personal clinical experience]. / Office surgery. Esperienza clinica personale.

BACKGROUND: A methodology which had a substantial development in the last decade: Office Surgery, is described. This is a branch of Day-Surgery, adapted to provate medical practice with the same characteristics of a Hospital Operating Unit with daily recovery. The aim of the study is to examine the costs-benefit of this methodology compared to international results. METHODS: The OS structure is described as well as the specific requirements needed for its hygienic-sanitary certification, giving particular attention to its structural characteristics, according to the relevant legislation and optimal functionality. The personal clinical experience is based on 1771 cases submitted to surgery in such a structure. The aim of the study is to compare the results with those reported by the international literature. The type of surgery performed was mainly esthetic-reconstructive, laser surgery, minor urology and phlebologic surgery. RESULTS: The results were promising, with a careful follow-up showing 65 cases of complications (3.6% of the treated cases), thanks also to an accurate criterium of patients' selection including various clinical evaluation parameters and a careful discharge followed by the physician. CONCLUSIONS: On the basis of the results, obtained it is possible to confirm that this discipline is interesting as far as patient's grading, cost control morbility and mortality index are concerned, even if it is limited to short-term surgery with local anesthesia or sedation, and low septic and hemorrhagic risk. However, a number of doubts still exists concerning the legislation of this methodology and a right clinical and insurance acknowledgment for the patient and the physician.