Results of Ulno-Dorsal Fascia Flap According to Becker/Gilbert after Interfascicular Neurolysis for Recurrent Carpal Tunnel Syndrome

Multiple revisions because of persistant complaints after carpal tunnel release lead to increasing fibrosis at the level of the median nerve and the surrounding tissue. Despite technically aedequate microsurgical intrafascicular release, hyperesthesia at the palmar wrist level may persist.

Between 1995 and 2002, five patients with recurrent compression complaints of the median nerve at the wrist level were treated with a mircosurgical intrafascicular neurolysis (according to Millesi) in combination with a pedicled fat-fascia flap (according to Becker/Gilbert). There were 4 female and 1 male patient. Their ages ranged from 36 to 55 years. In all patients, a minimum of 4 (4–7) previous operations had been performed. All patients had adequate pain treatment. In a retrospective clinical study, the following criteria were evaluated: 1) pain (analog scale 1–10); 2) sensibility (static 2PD); 3) active and passive ROM (neutral-0-method); 4) power and pinch grip (Jamar, Pinchmeter); and 5) subjective judgement of the flap donor site by the patient (excellent, acceptable, fair). The minimum follow-up was 18 months.

In all patients, reduction of pain from an average of 7/10 (heavy permanent pain under pain medication) to 4/10 (intermittent pain without permanent pain medication) occurred. There was no change in sensibility after operation. However, there was an increase in power grip from an average of 14 to 20 kg. The flap donor site was judged acceptable by all patients.

A combination of microsurgical interfascicular neurolysis with the ulno-dorsal fascia flap will lead to better vascularization at the palmar wrist region, better vascularization at the median nerve, and additional ”padding” of the neurolysed nerve. This leads to a significant amelioration but not to a complete pain-free status of the patient.