Recurrent carpal tunnel syndrome: treatment options

Many techniques are available to the surgeon confronted with a patient with recurrent nerve entrapment/traction neuritis. The advantage of local muscle or fat flaps like the ADQ, pronator quadratus, and hypothenar fat flap is the ease at which each can be elevated. The size is very limited, however. Circumferential vein wrapping has been studied extensively and is efficacious despite the absence of vascularity, but length requirements may limit the indications to short nerve segments, as might be expected with recurrent carpal tunnel syndrome. Despite the increased complexity of a pedicled flap and free tissue transfer, the tissue availability, girth, and source of vascularity make these sophisticated techniques more attractive. Such flap transfers should be used only after the more simple techniques have been ruled out as options or failed and only if residual pain and hypersensitivity are due to localized neuritis as opposed to a more generalized dystrophic symptomatology.