Protective Coverage of the Median Nerve Using Fascial, Fasciocutaneous or Island Flaps

Abstract

Protective coverage of the median nerve by using fascial or fasciocutaneous flaps after failure of CTR and/or unsuccessful re-operations is a good solution to furnish to the median nerve a gliding tissue to avoid adherences with the surrounding tissue of previous surgery. The protection of the nerve can reduce painful symptoms even if it does not permit a return to a painless condition. However, the clinical results in terms of median nerve functional recovery cannot be predicted: if the median nerve is damaged, protective coverage of it by flaps cannot give a favourable result in terms of recovery of both sensory and motor deficits.

Carpal tunnel syndrome and treatment of recurrent symptoms

“…In our experience, an ulnar fasciocutaneous flap [33,42] is a safe and simple technique to cover the median nerve after reexploration ( Figure 2), although there is an increased risk of necrosis of the flap in the hand bearing the arteriovenous fistula in patients being treated by haemodialysis ( Figure 3). After additional release of the median nerve, an ulnar fasciocutaneous flap, with or without a skin island as a survival indicator, is raised.…”

Vein wrapping at cubital tunnel for ulnar nerve problems

“…An appropriate material also should resist degradation, minimize inflammatory reaction, not induce immunologic reaction, and should not be a source of long-term compression of the nerve. Several options have been tried with varied success, including fascial, fasciocutaneous, island or free-flap coverage, 14,15,17,19,32 or our preferred technique using a vein graft. 5,31,34e39 The vein graft has the advantages of being simpler than the complex technical demands of flap coverage while still providing excellent coverage for the nerve and meeting the requirements outlined above.…”

Painful scar neuropathy: principles of diagnosis and treatment

“…[30,76] Reisman and Dellon [58] Abductor digiti minimi Median Pain reduction in 11/12 patients (91) Strickland et al [59] Hypothenar fat pad flap Median Excellent results in alleviating recalcitrant idiopathic CTS (95 satisfaction in 62 patients) Rose [60] Palmaris brevis muscle flap Median Complete pain relief in all patients (13 hands) (100) Jones [61] Pedicled or free flaps Median/ulnar Pain reduction in 7/9 patients (78) Giunta et al [62] Hypothenar fat pad flap Median Pain reduction in 8/9 patients (89) Frank et al [63] Hypothenar fat pad flap Median Pain reduction in 8/9 patients (89) Guillemot et al [64] Fat graft Median No pain reduction in 4 patients Mathoulin et al [65] Hypothenar fat pad flap Median Pain resolution in 41/45 patients (98) De Smet and Vandeputte [66] Hypothenar/ulnar fat pad flap Median Pain reduction in 9/14 patients (64) Dahlin et al [67] Pedicled ulnar, dorsal forearm flaps Free groin, scapular, lateral arm flaps Median Pain reduction in 10/14 patients (71) Goitz and Steichen [54] Free omental flaps Median Pain reduction in 7/11 patients (63) Luchetti et al [68] Fascial and fasciocutaneous island flaps (hypothenar fat pad, forearm radial artery, forearm ulnar artery, ulnar fascial fat, and posterior interosseous) Median Four point VAS score reduction in 23/25 patients (92) Craft et al [69] Hypothenar fat pad flap Median Pain resolution in 83% of 28 patients Fusetti et al [70] Hypothenar fat pad flap Median Pain reduction in 18/20 patients (90) Elliot et al [71] Vascularized forearm fascial flap Median/ulnar Pain resolution in 8/14 patients (57) Soltani et al [43] Collagen: neurolysis + collagen wrap Median/ulnar Resolution/improvement in 4 patients (median) Resolution in 3/4 patients (cubital tunnel syndrome) Espinoza et al [72] Microneurolysis alone versus ADCON/TN Median/ulnar Pain reduction in 80% of 54 patients Atzei et al [35] Neurolysis or nerve repair with Hyaloglide (R) Hand nerves Pain reduction quicker with Hyaloglide (R) 14 patients treated with HA versus 16 treated without gel Varitimidis et al [73] Autologous vein Median Pain reduction in 14/15 patients (93) Masear [74] Vein: autologous+allograft Median and various peripheral nerves…”