Reverse radial artery fascial flap: A treatment for the chronically scarred median nerve in recurrent carpal tunnel syndrome

Tham, Stephen; Ireland, Damian C.R.; Riccio, Michele; Morrison, Wayne A.

doi:10.1016/s0363-5023(96)80202-4

Cited by 83 publications

(60 citation statements)

References 31 publications

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“…While there are a variety of surgical techniques described for revision CTR, including tissue interposition flaps and nerve wrapping (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), such procedures were rarely performed in this series. We believe that any wrapping of the median nerve places it at unnecessary risk for iatrogenic compression.…”

Section: Discussionmentioning

confidence: 99%

“…However, most prior outcome studies of secondary CTR have focused on specific surgical techniques, such as the use of biologic or synthetic barriers for median nerve coverage, and have been limited by small sample size and poor application to wide groups of patients (13,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The objectives of this study were fourfold: 1) to describe the patient population undergoing secondary carpal tunnel surgery in a high-volume tertiary peripheral nerve center; 2) to relate patients' presenting symptoms (persistent/recurrent/new) to intra-operative findings; 3) to evaluate outcomes of revision CTR, including strength and pain measures, and their relationship to symptom classification; and, 4) to identify predictors of postoperative pain following revision surgery.…”

Section: Introductionmentioning

confidence: 99%

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Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

Davidge¹,

Zieske²,

Ebersole³

et al. 2013

The Journal of Hand Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

Davidge¹,

Zieske²,

Ebersole³

et al. 2013

The Journal of Hand Surgery

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“…We uphold that the reverse island radial artery flap has the greatest reliability and practicality [72].…”

Section: Introductionmentioning

confidence: 83%

“…46.4c). The fascial flap is turned down distally and buried under the flexor carpi radialis muscle in such a way that its gliding surfaces wrap around the median nerve in a dorso-volar direction, enveloping its entire circumferential length within the carpal tunnel [72] (Fig. 46.5).…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…These perforators usually directly supply the fascia but sometimes can follow an indirect ascending course perforating the surface of the flexor carpi ulnaris. Cases have been documented where there has been a complete lack of ascending branches from the ulnar artery to the overlying fascia [72]. The ulnar island flap's venous drainage is through the deep venae comitantes which, like the radial flap, has a retrograde flow, and is made up of a complex vessel network found around the ulnar artery.…”

Section: Anatomymentioning

confidence: 99%

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Reverse Island Forearm Flaps for the Coverage of the Median Nerve in Recurrent Carpal Tunnel Syndrome

Riccio

Bertani

Morrison

Carpal Tunnel Syndrome

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Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

et al. 2013

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Treatment of recurrent carpal tunnel syndrome (CTS) is challenging, especially in a case with recurrent CTS and a neuroma formation. Resection of the neuroma causing the syndrome, reconstruction of the nerve gap of the median nerve, and covering up the reconstructed median nerve with well-vascularized soft tissue for prevention of CTS re-recurrence are the essential procedures. We report a case of recurrent CTS with severe pain due to a neuroma-in-continuity successfully treated using a free anterolateral thigh (ALT) flap with a vascularized lateral femoral cutaneous nerve (LFCN). A 2 cm neuroma existed in the median nerve and was resected. The nerve gap was repaired using a vascularized LFCN included in the ALT flap. The ALT flap was transferred to the wrist to cover the median nerve. The severe pain disappeared completely and the sensory and motor impairment of the median nerve improved 5 months after the free flap surgery, as the Tinel's sign moved distally away from the wrist and disappeared. The result of the Semmes-Weinstein test improved from 5.08 to 4.31 and she was able to flex and extend the right wrist and fingers without pain. CTS did not recur 15 months after the surgery. A free ALT flap with vascularized LFCN allows nerve reconstruction for the median nerve gap created after neuroma resection and coverage of the median nerve with well-vascularized soft tissue to prevent adhesion and CTS recurrence.

show abstract

Reverse radial artery fascial flap: A treatment for the chronically scarred median nerve in recurrent carpal tunnel syndrome

Cited by 83 publications

References 31 publications

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

Reverse Island Forearm Flaps for the Coverage of the Median Nerve in Recurrent Carpal Tunnel Syndrome

Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

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