CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2021; 49(01): 079-087
DOI: 10.1055/s-0041-1730391
Surgical Technique | Técnica Quirúrgica

First Lumbrical Muscle Flap for Recurrence of Carpal Tunnel Syndrome: Anatomical Study and Surgical Technique

Article in several languages: English | español
1  Orthopedic Surgery and Traumatology Service, Hospital Universitario Infanta Leonor, Madrid, Spain
,
1  Orthopedic Surgery and Traumatology Service, Hospital Universitario Infanta Leonor, Madrid, Spain
2  Hand Surgery Unit, Hospital Universitario Quironsalud, Madrid, Spain
3  Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
,
1  Orthopedic Surgery and Traumatology Service, Hospital Universitario Infanta Leonor, Madrid, Spain
,
1  Orthopedic Surgery and Traumatology Service, Hospital Universitario Infanta Leonor, Madrid, Spain
2  Hand Surgery Unit, Hospital Universitario Quironsalud, Madrid, Spain
,
4  Department of Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
,
1  Orthopedic Surgery and Traumatology Service, Hospital Universitario Infanta Leonor, Madrid, Spain
3  Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
› Author Affiliations

Abstract

Recurrence of carpal tunnel syndrome implies the reappearance of symptoms after release surgery. If the cause of recurrence is not an incomplete release, but a traction neuritis, the tendency is to add to the revision surgery of the carpal tunnel the use of flaps to cover the median nerve. These flaps establish a physical barrier between the nerve and the rest of the adjacent structures, preventing adhesions, and providing neovascularization and better nerve sliding.

In the present work, we detail a revision surgery in which the first lumbrical muscle is used as a covering flap. This flap has two benefits. Firstly, it acts as a vascularized coverage for the median nerve (avoiding the formation of fibrosis and favoring its sliding); secondly, a structure that takes up space is removed from the carpal tunnel, thus reducing the pressure within it.

Along with the explanation of the technique, the present article provides a detailed description of the anatomical variability of the first lumbrical muscle and its vascularization, as well as the results of a cadaveric study on the location of the vascular pedicle of the first lumbrical muscle.



Publication History

Received: 07 February 2021

Accepted: 08 March 2021

Publication Date:
02 July 2021 (online)

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