Synovial Flap for Recurrent Carpal Tunnel Syndrome: Long-Term Follow-Up

Recurrent carpal tunnel syndrome is a challenging surgical problem. Revision carpal tunnel release with vascularized flap coverage is indicated when scarring around the median nerve is believed to be the culprit for recurrence. Synovial flap coverage at the time of neurolysis is a described technique, but long-term results have not been reported. Our aim is to evaluate and present long-term outcomes (>1 year) of patients with recurrent carpal tunnel syndrome treated with carpal tunnel release and synovial flap coverage.

A retrospective review identified 17 patients who underwent revision carpal tunnel release combined with synovial flap coverage performed by the senior author over a 10-year time frame. Patient demographics and preoperative symptoms were collected. All patients were contacted via telephone. Fourteen patients completed follow-up surveys including the QuickDASH and Boston Carpal Tunnel Questionnaire (BCTQ). Data were analyzed using a Fisher exact test with a significance set to a P value <0.05.

Of the 14 survey participants, 10 had good outcomes based on a BCTQ score <2 (71.43%), and 11 had good outcomes based on a QuickDASH score ≤34 (78.57%). All patients considered the surgery successful, and 13 would elect to undergo the surgery again. No patients required an additional release. No specific patient characteristics or preoperative symptoms were associated with a poor outcome. There were no major complications.

Revision carpal tunnel release with synovial flap coverage demonstrated good long-term patient-reported outcomes. This is a reliable, effective treatment option for this challenging condition.