Erkan Sabri ERTAŞ, Musa ERGİN, Ali ÖZDEMİR
Gulhane Medical Journal - 2026;68(3):186-191
Aims: This study evaluates intraoperative anatomical variations encountered during open carpal tunnel release (CTR) and aims to determine the prevalence of the persistent median artery (PMA) encountered during open CTR and to evaluate its anatomical features, clinical significance, and surgical outcomes. Methods: This retrospective observational study reviewed the operative reports of patients who underwent open CTR at our institution between January 2015 and April 2024. Adults diagnosed with carpal tunnel syndrome based on clinical and electrophysiological findings who were treated with isolated open CTR were included. Patients undergoing additional wrist procedures or revision CTR were excluded. The primary endpoint was the intraoperative identification of PMA, defined as an artery persisting within the carpal tunnel. Operative notes were examined to record their anatomical course and management. Results: A total of 1,032 patients underwent CTR [mean age 53.4+/-11.6 years; 678 females (65.7%)]. PMA was identified in 9 cases (0.9%), with a mean age of 51.2+/-8.7 years and predominance in females (66.7%). The PMA coursed superficial to the median nerve in 6 patients (66.7%) and deep to the median nerve in 3 patients (33.3%). All arteries were preserved, and no intraoperative vascular or neural injuries occurred. The mean postoperative follow-up duration was 6.2+/-2.4 months. No hematoma, wound complications, or symptom recurrence were reported during the follow-up period. Conclusions: PMA is a rare anatomic variant encountered in less than 1% of open CTR procedures. Its close relationship with the median nerve, although rare, emphasizes the importance of careful dissection. Recognition of this structure intraoperatively may help minimize complications and ensure safe surgical outcomes.
