Artikel
Surgery and Rehabilitation Following Revision Open Carpal Tunnel Release with Hypothenar Fat-pad Flap
Suche in Medline nach
Autoren
-
Thomas Maxwell
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
-
Wilma Walsh
- Extend Rehabilitation, Brisbane, Australia
-
Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
| Veröffentlicht: | 6. Februar 2020 |
|---|
Gliederung
Text
Objectives/Interrogation: Scar adhesions of the median nerve in the carpal tunnel (CT) following open carpal tunnel release (OCTR) can result in recurrent CT syndrome with pain, sensory and motor deficits. Revision surgery with pedicled hypothenar fat-pad flap (HFPF) aims to prevent re-adherence of scar tissue and improve perineural vascularity. This study reports the outcomes of patients undergoing revision OCTR with HFPF.
Methods: This is a prospective study of a consecutive sample of 13 patients (14 wrists) who underwent revision OCTR with HFPF and were assessed preoperatively and at 6 weeks, 3, 6 & 12 months or greater post-op. 6 wrists (42.9%) were female and 11 (78.6%) dominant. Median patient's age at surgery was 60 (range 39 - 78) years and median follow-up time was 14 (range 1.5 - 36) months. Nine wrists had had one prior operation, three wrists had had 2, one wrist had had 3, and one wrist had had several prior operations. Median interval from most recent CTR was 36 (range 4 - 240) months.
The following measures were used for assessment: Levine's CT Questionnaire (LCTQ), QuickDASH and Patient Rated Wrist and Hand Evaluation (PRWHE), pain (Visual Analogue Scale), grip and pinch strength, and improvement using the Global Rating of Change (GRC). Comparisons are made between data collected before the surgery and at most recent follow-up equal or greater to 12 months (n=7). Results are reported as median (25% - 75%).
Results and Conclusions: LCTQ scores for symptoms decreased from pre-operative value of 3.6 (1.9 - 2.7) to 2.5 (1.3 - 1.4) at last follow-up. PRWHE scores dropped from 41.5 (15 - 57) at baseline to 16.3 (1.6 - 55.4) at last follow-up, paralleled by QuickDASH scores which dropped from 42.5 (22.7 - 54.6) to 31.8 (13.6 - 43.2). Pain diminished throughout the time course from 41 (15.3 - 60.5) to 7.5 (4 - 39).
Grip and pinch strength were maintained from baseline to most recent follow-up from 20.3 (10.9 - 28.8) to 16.1 (9.3 - 22.9) in grip, 4.0 (2.0 - 5.5) to 5.3 (2.9 - 5.6) in lateral pinch strength and 3.5 (2.3 - 5.0) to 2.9 (2.4 - 3.8) in tip-to-tip pinch strength. Finally, GRC scores for symptoms and function were positive and tended to increase from 5 (3.3 - 6.8) at 6 weeks post-operative to 6 (0 - 7) at final follow-up and from 3 (-2 - 5.5) to 4 (-1 - 5.5) respectively.
These results, combined with those presented in the literature, suggest that OCTR with HFPF shows outcomes better than revision without flap while being much simpler than other pedicled and free flaps.
