Treatment of Recurrent and Persistent Carpal Tunnel Syndrome: The Fasciocutaneous Dorsal Ulnar Artery Flap

Abstract

Surgical treatment of recurrent and persistent carpal tunnel syndrome by repeat carpal tunnel release combined with soft tissue nerve coverage results in a higher success rate for symptomatic relief in the presence of a scarred median nerve. Several techniques, including local pedicled flaps, transposition flaps from the distal forearm, and free flaps, have been described, but consensus regarding a preferred technique has not been reached. The dorsal ulnar artery flap or Becker flap is a local fasciocutaneous flap based on a dorsal perforating branch of the ulnar artery that can be used for soft tissue coverage of the median nerve. Advantages of this technique are the quick and easy dissection and low donor site morbidity. Studies of its use for the treatment of recurrent carpal tunnel syndrome are limited.

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war

“…Distal-based fasciocutaneous flaps on the forearm have proven to be simple use, versatile and reliable flaps; they can be used to reconstruct a wide variety of soft tissue defects of the hand. [ 20 ] In this sense, PIF has aroused increasing interest in plastic hand surgeons and is one of the most frequently used skin flaps in reconstructive surgery. [ 11 , 16 , 17 ] Although it has support from the anterior interosseous artery, it has low arterial pressure.…”

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

“…13 However, failures and recurrence have been shown to occur in 3 to 19% in large series, necessitating revision surgery in up to 12% of the cases. 13,[18][19][20][21][22] Although possible reasons for the recurrent carpal tunnel syndrome have been hypothesized, such as an incomplete release of the transverse carpal ligament or the proximal antebrachial fascia, formation of epineural fibrosis and interstitial scar, and soft tissue adhesion to the nerve, its pathogenesis is still not clear. 13,23,24 Furthermore, some patients develop an excessive neuropathic pain beyond that normally experienced after a microsurgical repair of the peripheral nerves.…”

“…Several local flaps (hypothenar fat pad flap, tenosynovial flap), muscle flaps (abductor digiti minimi, pronator quadratus, palmaris brevis), regional flaps (reverse island radial artery fascial flap, posterior interosseous artery flap), and free flaps (anterolateral thigh flap, omental transfer, temporoparietal fascial flap) have been described. 12,22,[26][27][28][29][30][31][32][33][34][35] However, these procedures have some disadvantages. The hypothenar fat pad flap has a limited volume and mobility to cover the large area of scarring over the median nerve, except for the carpal tunnel region.…”

“…6 Moreover, the ulnar artery perforator adipofascial flap has also been used for vascularized coverage of the median nerve. 7,9,22 Adani et al reported the outcomes of eight patients with painful median nerve neuromas treated with external neurolysis and covered with radial or ulnar artery perforator adipofascial flaps. 3 Irifune et al also presented two patients with recurrent adhesion neuropathy with allodynia after wrist lacerations treated successfully with radial and ulnar artery perforator adipofascial flaps.…”

Subcutaneous Dorsomedial Triangle of Forearm: Surgical Anatomy and Clinical Implication

“…Soft tissue defects of the hand and wrist are a real challenge for plastic surgeons to preserve hand functions and allow early rehabilitation [ 1 , 2 ]. The anatomical knowledge of the dorsal branch of the ulnar nerve (DBUN) and ulnar artery (DBUA) plays a significant role in designing neurocutaneous flaps for reconstructive surgeries of the hand [ 3 ].…”