The hypothenar fat pad transposition flap: a modified surgical technique

The hypothenar fat pad flap has been shown to produce reliable clinical results for the treatment of recurrent carpal tunnel syndrome secondary to cicatricial tethering. The flap utilizes soft vascularized tissue that does not compromise hand function and is of sufficient size to provide median nerve coverage in the carpal tunnel. We describe technical modifications that facilitate improved, tension-free transposition of the pedicled fat pad flap. These modifications enable transfer of vascularized tissue and decrease iatrogenic damage to the important perforator vessels. The hypothenar fat pad transposition flap provides a reliable source of vascularized local tissue that can be used successfully as an adjunct to neurolysis for the treatment of recurrent idiopathic CTS secondary to perineural scarring.