Article

Several techniques are available for revision surgery of carpal tunnel syndrome
(CTS) to preserve a gliding layer and protect the median nerve, including
Strickland's pedicled hypothenar fat pad flap. The objective of this
single-center, prospective study was to report the results of this flap after a
minimum follow-up of two years. Between March 2006 and April 2014, 34 patients
were enrolled (mean age 67 years) who had postoperative complications after the
primary surgical release of CTS with nighttime paresthesia and/or neuropathic
pain and abnormal electromyography findings. All patients were operated on using
the same technique: neurolysis of the median nerve in the carpal tunnel with the
nerve protected by a Strickland flap. The preoperative and postoperative
evaluations consisted of questionnaires (paresthesia, neuropathic pain using the
VAS and DN4 score, QuickDASH) and a clinical examination (grip strength, Weber
two-point discrimination, atrophy of thenar muscles). Eighteen patients were
reviewed in person and sixteen over the telephone. The outcomes were analyzed
after at least 24 months' follow-up for all patients and 60 months for 13
patients. At 24 months postoperative, nighttime paresthesia was present in 3 of
34 patients and neuropathic pain in 2 of 24 patients. There was a significant
reduction in pain on the VAS in all 34 patients (1.4 versus 6.4), the DN4 score
(1.3 versus 5.7) and QuickDASH (60.7 versus 19.8). Of the 18 patients examined,
grip strength improved from 72% to 86% of the opposite side (P<0.05), the mean
static Weber was 6.4mm (versus 7.1mm preoperatively); nine patients had atrophy
of the thenar muscles (versus eight preoperatively). The results observed at two
years were maintained at five years' follow-up. This flap appears to improve the
subjective neurological signs of CTS.
CI - Copyright (c) 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS