gms | German Medical Science

Objectives/Interrogation: The release of the transverse carpal ligament as a management of the obstructive syndrome of the median nerve generally brings good results, however some patients persist with symptoms that are attributed to an incomplete release or a fibrous process in the periphery of the nerve, thus there are descriptions other surgical techniques whose purpose is to interpose tissue between the nerve and the scar as the hypothenar fat flap.

The purpose of the article is to describe the results obtained with the identification of a preforant for the placement of the hypothenar fatty flap in the management of recurrent carpal tunnel syndrome.

Methods: We present the case of a 60-year-old female patient with a history of conventional release of the right-side carpal tunnel of 1 year of evolution, with persistence of paresthesias, allodynia, dysesthesia and decreased strength associated with alterations in postoperative electromyography and neuroconduction, so an incomplete release is interrogued. Surgical management with hipotenar fatty flap was decided, for which a perforator was marked at the level of the hypothenar region with the help of an 8Mhz Doppler

Results and Conclusions: The persistence of symptoms after the release of the carpal tunnel may be secondary to an incomplete release of the transverse carpal ligament, to scar compression or to both noxas. The literature indicates surgical management in which the use of hypotenar fat flap has given satisfactory results, in the patient also the use of Doppler was implemented as a guide evidencing safety, easiness and effectiveness in the procedure.