Coverage of the median nerve with free and pedicled flaps for the treatment of recurrent severe carpal tunnel syndrome

Fifteen patients (10 women and 5 men; median age 46 years; range 28-55), with recurrent severe carpal tunnel syndrome, were operated on with re-exploration and cover of the median nerve with free or pedicled flaps (five pedicled ulnar flaps, one pedicled dorsal forearm flap (served by the posterior interosseus artery), one groin flap, three free scapular flaps, and five free lateral arm flaps). The patients were followed up by a self-administered questionnaire at 3 months-14 years (median 8.5 years) after operation and replies were obtained from 14 patients. There was a significant improvement in pain (p = 0.01) and percussion tenderness at the wrist (p = 0.02), but no significant improvement in allodynia and cold intolerance in the hand as evaluated by the use of a visual analogue scale (VAS). Three of the 14 patients had less numbness/paraesthesiae and four had subjectively improved sensory function in the hand and fingers since the procedure. Ten patients had problems from the donor site, including a cosmetically unacceptable scar, allodynia, and itching. Four patients had worked before the operation and nine patients returned to ordinary or light work afterwards. In conclusion, 10/14 patients considered themselves as somewhat better, better, or cured, while four felt that they were unchanged or worse. We conclude that cover with vascularised fat may be worthwhile in some patients with recurrent severe carpal tunnel syndrome, preferably with a simple pedicled ulnar flap.