The hypothenar fat pad flap for management of recalcitrant carpal tunnel syndrome

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

“…Early in the study period, hypothenar fat flaps were performed for nerve coverage in patients with major incisional pain. However, despite other reports (17,18,22) we did not find this procedure to be of benefit in alleviating symptoms. To encourage postoperative nerve gliding, we therefore advocate short periods of immobilization (2-3 days) and early, protected range of motion.…”

“…While there are a variety of surgical techniques described for revision CTR, including tissue interposition flaps and nerve wrapping (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), such procedures were rarely performed in this series. We believe that any wrapping of the median nerve places it at unnecessary risk for iatrogenic compression.…”

“…However, most prior outcome studies of secondary CTR have focused on specific surgical techniques, such as the use of biologic or synthetic barriers for median nerve coverage, and have been limited by small sample size and poor application to wide groups of patients (13,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The objectives of this study were fourfold: 1) to describe the patient population undergoing secondary carpal tunnel surgery in a high-volume tertiary peripheral nerve center; 2) to relate patients' presenting symptoms (persistent/recurrent/new) to intra-operative findings; 3) to evaluate outcomes of revision CTR, including strength and pain measures, and their relationship to symptom classification; and, 4) to identify predictors of postoperative pain following revision surgery.…”

Primary Familial Carpal Tunnel Syndrome with Long-term Followup: A Study of Two Families and Review of the Literature

“…Our average overall follow-up of 13.5 y for all three FCTS patients also represents one of the longest in the literature. This information may enhance the ability of clinicians who treat these patients to appropriately counsel individuals regarding expected outcomes and the potentially higher likelihood of recurrent symptoms over time [35][36][37][38][39][40].…”

Painful scar neuropathy: principles of diagnosis and treatment

“…[30,76] Reisman and Dellon [58] Abductor digiti minimi Median Pain reduction in 11/12 patients (91) Strickland et al [59] Hypothenar fat pad flap Median Excellent results in alleviating recalcitrant idiopathic CTS (95 satisfaction in 62 patients) Rose [60] Palmaris brevis muscle flap Median Complete pain relief in all patients (13 hands) (100) Jones [61] Pedicled or free flaps Median/ulnar Pain reduction in 7/9 patients (78) Giunta et al [62] Hypothenar fat pad flap Median Pain reduction in 8/9 patients (89) Frank et al [63] Hypothenar fat pad flap Median Pain reduction in 8/9 patients (89) Guillemot et al [64] Fat graft Median No pain reduction in 4 patients Mathoulin et al [65] Hypothenar fat pad flap Median Pain resolution in 41/45 patients (98) De Smet and Vandeputte [66] Hypothenar/ulnar fat pad flap Median Pain reduction in 9/14 patients (64) Dahlin et al [67] Pedicled ulnar, dorsal forearm flaps Free groin, scapular, lateral arm flaps Median Pain reduction in 10/14 patients (71) Goitz and Steichen [54] Free omental flaps Median Pain reduction in 7/11 patients (63) Luchetti et al [68] Fascial and fasciocutaneous island flaps (hypothenar fat pad, forearm radial artery, forearm ulnar artery, ulnar fascial fat, and posterior interosseous) Median Four point VAS score reduction in 23/25 patients (92) Craft et al [69] Hypothenar fat pad flap Median Pain resolution in 83% of 28 patients Fusetti et al [70] Hypothenar fat pad flap Median Pain reduction in 18/20 patients (90) Elliot et al [71] Vascularized forearm fascial flap Median/ulnar Pain resolution in 8/14 patients (57) Soltani et al [43] Collagen: neurolysis + collagen wrap Median/ulnar Resolution/improvement in 4 patients (median) Resolution in 3/4 patients (cubital tunnel syndrome) Espinoza et al [72] Microneurolysis alone versus ADCON/TN Median/ulnar Pain reduction in 80% of 54 patients Atzei et al [35] Neurolysis or nerve repair with Hyaloglide (R) Hand nerves Pain reduction quicker with Hyaloglide (R) 14 patients treated with HA versus 16 treated without gel Varitimidis et al [73] Autologous vein Median Pain reduction in 14/15 patients (93) Masear [74] Vein: autologous+allograft Median and various peripheral nerves…”