Abstract
Aims
The objective of our study is to identify the causes for recurrence and to evaluate the results of our technique.
Material and Methods
We retrospectively analysed 18 patients (12 females; 6 males) who had both clinical and electrophysiological confirmation (7 focal entrapments; 11 severe entrapments) of recurrent carpal tunnel syndrome. In all the patients, after releasing the nerve a vascularised fat pad flap was mobilised from hypothenar region and sutured to the lateral cut end of flexor retinaculum. All the patients were assessed post-operatively for relief of pain, recovery of sensory and motor dysfunction.
Results
The average age was 61 years and dominant hand was involved in 13/18. The average time between the first and second surgery was fifty-nine months. Intra-operatively ten had completely reformed retinaculum, two partially reformed (proximally) and five had scar tissue between the cut ends and one had scar tissue and fibrosis around the nerve. All patients had improvement of symptoms post-operatively. Ten had complete recovery immediately after surgery, the remaining patients had severe focal entrapment and had scar tissue intraoperatively. The patients with delayed recovery had high incidence of a) Early recuurence (average of nine months), b) Diabetes mellitus c) Obese/over-weight and d) cervical spine problems.
Conclusions
The hypothenar fat pad transposition flap provides a reliable source of vascularised local tissue that prevents scar formation and helps nerve gliding. 80% of the patients in whom recurrence occurred within a year are associated with poor outcome/delayed recovery.
