Autologous Fat Transfer in Secondary Carpal Tunnel Release

Carpal tunnel release is the gold standard for the treatment of median nerve compression disease. Recurrent or persistent symptoms do not occur in most patients, although a small number of them have indicated that such a postoperative condition indeed exists. Some patients undergo repeated treatments. In the majority of the cases, the disease is associated with scarring in the carpal tunnel or even reformation of the carpal ligament. The authors propose the usage of autologous fat grafting during secondary carpal tunnel release to inhibit the scarring process.

Ten patients with recurrent or persistent symptoms underwent autologous fat grafting at the time of their repeated carpal tunnel release. Fat was harvested from the lower abdomen and grafted into the scarred transverse carpal ligament and surrounding tissues. Each patient underwent pre- and postoperative examinations and completed the carpal tunnel questionnaire (Boston) to evaluate their sensory and motor functions. The patients underwent 1 year of follow-up.

There were 2 main reasons for continued symptoms: a technical mistake resulting in incomplete release (IR) during the first operation and abundant scarring (ABS) in the operated area. The beneficial effects of the interventions were confirmed by a clinical study and by administering the carpal tunnel questionnaire to all patients (functional severity score decreased from 4.38 to 1.88 in IR and 3.62 to 1.48 in ABS group, sensory severity score from 3.26 to 1.7 in IR and 3.04 to 1.48 in ABS group; P < 0.05) after 12 months of follow-up.

Our initial observations suggest the possible efficacy of adipose tissue in secondary carpal tunnel release.