Perforator-based radial forearm fascial flap for management of recurrent carpal tunnel syndrome

Purpose To study the benefit of using the perforator-based radial forearm fascial flap for patients with recurrent carpal tunnel syndrome. Methods We used a perforator-based radial forearm fascial flap in 8 patients to cover the median nerve. All of the patients had undergone an index carpal tunnel release, and 3 of them had undergone at least 1 revision surgery to further decompress the median nerve. Results At average of 20 months (range, 6-30 mo) after the forearm fascial flap, all patients reported symptomatic improvement with complete resolution of nighttime symptoms. No patient reported worsening of symptoms; however, some subjective parasthesias persisted in 3 of the 8 patients. Objective assessment revealed complete resolution of a Tinel sign in 5 of 8 patients and noteworthy improvement in the remaining 3 patients. Average 2-point discrimination was 10.0 mm before surgery and 5.4 mm after surgery, average grip strength improved from 13.5 kg to 21.0 kg, and average tip pinch strength improved from 4.1 kg to 7.0 kg. Conclusions The perforator-based radial forearm fascial flap may prove useful in the setting of recurrent carpal tunnel syndrome after surgical decompression. Level of evidence Therapeutic IV.