gms | German Medical Science

Objectives/Interrogation: Present a techinical proposal and show the results of the hipotenar fat flap for the recurrence of failure or recurrence of carpal tunnel release

Methods: This is a retroscpective study with a prospective data collection, all the surgeries peformed by the same surgeon.

Between February of 2014 and March of 2018, 20 patients were operated for carpal tunnel recurrence with the techinique of hipotenar fat flap.

13 participate the study, not for exclusion criteria, but because 7 were not avaliable to answer the questionarie ou to sign up the formularie.

The group were composed for 1 man and 12 women.

Related to the side operated 5 were right side and 8 left side.

The average time between the first and the second surgery was 3 years.

The medium follow up between the surgery and final evaluation was 54 moths (6 months to 48 months).

The technique consisted in a "L" approach begining in the distal palmar crease, in line with the radial border of the 4º finger in a curve longitudinal fashion to the wrist crease, continuing transversaly to the pisiform. The skin was elevated leaving the subcutaneous tissue (hipotenar fat pad) attached to the hand. Then, the carpal tunnel was open, and all the synovits was taken off beneath the tendons, and the median nerve was cleaned as well, sometimes removing part of the epineurium. The flap was raised preserving its vascularity by branches of the ulnar artery. The flap was transposed to cover de carpal tunnel and the skin over it.

Results and Conclusions: The results were evaluated by the Quick Dash Score.

The data was collect pre and pos operative.

The average Quick Dash score was pre operative 80.65 (range 61.3 to 100), and pos operative 40,65 (range 11.3-70).

The worst pacientes were those with multiple surgery in the same member ou another, and those who were out of work, receiving benefits from social security (7 patients).

In this study, analysing the results, the hipotenar fat flap improves the symptoms of carpal tunnel recurrence, being a simple and low cost technique, and promotes a good coverage of the nerve and tendons, in a scared tissue surroundings, being a good option in this situation.

Unfortunatelly, we observe that the results are very heterogenous, some patients that improved a lot, and some that not improved at all. The reason to that could be explained by many ways: time in between the two surgery (3 years in average), extend of impairment of the nerve, works compensation and clinical conditions in some of them.