Management of true recurrent carpal tunnel syndrome: is it worthwhile to bring vascularized tissue?

Since 1989, 13 consecutive cases of true recurrent carpal tunnel have been operated on. Average delay before reoperation was 20 months (3 to 60 months). Intraoperative findings were univocal: extensive fibrosis with nerve adhesion to the roof of the carpal tunnel and a lack of nerve gliding. Surgery performed was: extensive external neurolysis from distal forearm to distal to carpal tunnel to allow a complete freedom of the nerve. A vascularized flap was never performed. Mean follow-up was 27.5 months (range 4 to 74 months). Results were: complete relief of symptoms in 75%; improvement with complete disappearance of nocturnal symptoms but persistent dysesthesia in 17%; no improvement in one patient (Sudeck's dystrophy). Interests of this study are: homogeneous population (only true recurrence), no bias from work compensation, consecutive cases, one surgeon, standardized surgical procedure and one independent observer. Results suggest that main factor for true recurrent carpal tunnel syndrome is lack of normal gliding of the nerve and that an extensive neurolysis helps to restore this gliding.