Perforator-Based Radial Forearm Fascial Flap for Management of Recurrent Carpal Tunnel Syndrome

A case series of seven patients with recurrent median nerve neuropathy treated by the revision surgery of median nerve neurolysis and wrapping with radial artery perforator adipose flap

“…4, 6-9, 22, 36 Mahmoud et al reported the benefit of using the perforator-based radial forearm fascial flap in eight patients with recurrent carpal tunnel syndrome. 8 Zahra et al successfully treated 15 patients with recurrent or persistent carpal tunnel syndrome by vascularization of the median nerve using a tubed adipofascial radial artery perforator flap. 6 Moreover, the ulnar artery perforator adipofascial flap has also been used for vascularized coverage of the median nerve.…”

“…1,2 Recently, it has been reported that some kinds of perforator flaps can be applied not only for skin and soft tissue defects, but also for covering the peripheral nerves. [3][4][5][6][7][8][9][10] In the case of revision surgery for chronic compressive neuropathy and peripheral nerve repair, as the peripheral nerves often adhere to the surrounding tissue, neurolysis in an already scarred tissue bed can create additional adhesions, leading to a secondary nerve dysfunction or eventual symptom recurrence. Thus, in a revision surgery, covering the neurolysed peripheral nerves with a well-vascularized soft tissue, such as a muscle, adipofascial, or a perforator flap, is necessary for providing a healthy tissue bed owing to a cushion effect and preventing recurrent adhesion neuropathy.…”

Autologous Fat Transfer in Secondary Carpal Tunnel Release

“…In cases involving scarring disorders, some methods of covering nerve fibers have been proposed. Tissue interposition flaps such as the radial artery fascial flap, 19 perforator-based radial forearm fascial flap, 20 thenar or hypothenar fat pad flap, 21 and different types of muscular flaps have been developed. 17 Most of these flaps require demanding procedures that warrant the preparation of an extensive range of adjacent tissues.…”

Carpal tunnel syndrome: state-of-the-art review

“…The vascularized coverage for the median nerve is often recommended. Coverage methods include Strickland's hypothenar fat flap, an abductor digiti minimi flap or a radial artery perforator fascial flap [6,14,49]. Krzesniak et al proposed the use of autologous fat transfer during secondary carpal tunnel revision.…”