The hypothenar fat pad transposition flap: a modified surgical technique

Area of Science:

• Hand surgery
• Plastic surgery
• Microsurgery

Background:

• Recurrent carpal tunnel syndrome (CTS) often results from scar tissue (cicatricial tethering) after initial surgery.
• Existing treatments may not fully address the median nerve coverage needs in complex recurrent CTS cases.
• The hypothenar fat pad is a local source of vascularized tissue suitable for reconstructive purposes.

Purpose of the Study:

• To describe technical modifications for an improved hypothenar fat pad flap transposition.
• To evaluate the flap's efficacy as an adjunct to neurolysis for recurrent idiopathic CTS.
• To demonstrate the flap's ability to provide tension-free median nerve coverage.

Main Methods:

• Description of surgical technique for pedicled hypothenar fat pad flap transposition.
• Focus on modifications to ensure tension-free transfer and protect perforator vessels.
• Application of the flap as an adjunct to neurolysis in patients with recurrent CTS.

Main Results:

• The modified hypothenar fat pad flap provides sufficient, vascularized tissue for median nerve coverage.
• The technique facilitates tension-free flap transposition, minimizing iatrogenic damage.
• The flap serves as a reliable adjunct to neurolysis, yielding positive clinical outcomes in recurrent CTS.

Conclusions:

• The modified hypothenar fat pad transposition flap is a reliable technique for recurrent carpal tunnel syndrome.
• This method effectively addresses median nerve coverage challenges in cases of perineural scarring.
• The flap preserves hand function while providing essential vascularized tissue for reconstruction.