A reliable and simple solution for recalcitrant carpal tunnel syndrome: the hypothenar fat pad flap

The incidence of failure in open carpal canal tunnel decompression is underestimated. Recurrence is often the result of scarring of the median nerve. Conservative treatment or careful neurolysis is usually insufficient. The hypothenar fat pad flap interposes adipose tissue from the hypothenar eminence and could offer a solution for patients with recalcitrant carpal tunnel syndrome. We reviewed the results of using this procedure in 20 patients with recalcitrant carpal tunnel syndrome and analyzed subjective and objective results, complications, and pitfalls. For 18 patients, pain disappeared completely. Two-point discrimination improved from an expanded range to normal in 16 of the 20 patients. Quick DASH (Disabilities of the Arm, Shoulder, and Hand) scores improved significantly. The hypothenar fat pad flap, a technically simple procedure, prevents median nerve readherence, produces excellent results, and should be included among the tools any surgeon uses for carpal tunnel surgery.