Recalcitrant carpal tunnel. The hypothenar fat pad flap

Area of Science:

• Hand Surgery
• Orthopedics
• Plastic Surgery

Background:

• Carpal tunnel syndrome (CTS) often requires surgical intervention.
• Recalcitrant or unrelieved CTS presents unique surgical challenges.
• Median nerve re-adherence can occur after initial decompression.

Purpose of the Study:

• To evaluate the efficacy of the hypothenar fat pad flap for treating recalcitrant idiopathic carpal tunnel syndrome.
• To assess the flap's ability to prevent median nerve readherence and improve nerve function.

Main Methods:

• A hypothenar fat pad flap was utilized for median nerve coverage during re-exploration for persistent CTS.
• The flap was mobilized and positioned as a barrier between the median nerve and the transverse carpal ligament.

Main Results:

• The hypothenar fat pad flap provided a well-vascularized tissue coverage for the median nerve.
• The procedure demonstrated effectiveness in preventing median nerve readherence.
• Improved median nerve excursion and patient outcomes were observed compared to previous techniques.

Conclusions:

• The hypothenar fat pad flap is a technically simple and reliable option for recalcitrant idiopathic carpal tunnel syndrome.
• This flap can enhance the tissue environment for the median nerve, promoting better functional recovery.
• Hand surgeons should consider the hypothenar fat pad flap in their surgical armamentarium for complex CTS cases.