The use of perforator radial fascial forearm flap in the management of recurrent carpal tunnel syndrome

Background
Management of recurrent carpal tunnel syndrome is considered a challenge for hand surgeons. We treated this clinical entity using a novel technique involving pedicled tissue transfer using a perforator-based radial-sided fascial forearm flap.
Patients and methods
The procedure was performed in six patients, all of whom had undergone previous failed surgery to release the median nerve and a period of initial relief not less than 3 months.
Results
At an average of 24 months following the procedure, all patients reported symptomatic improvement with complete resolution of night-time symptoms. No patient reported worsening of symptoms postoperatively; however, subjective paresthesias persisted in three of the six patients. Objective assessment revealed complete resolution of Tinel's sign in half of the patients and significant improvement in the other half. The average two-point discrimination improved from 10 mm preoperatively to 6 mm postoperatively, and the average postoperative grip strength improved from 11 to 20 kg.
Conclusion
The radial perforator-based fascial forearm flap is a useful option in the management of selected patients with recurrent carpal tunnel syndrome.