Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient’s Satisfaction and Improved Functionality
Abstract
:1. Introduction
2. Material and Methods
2.1. Patient Selection
2.2. Pre- and Postoperative Investigations
2.3. Operative Technique
2.4. Statistical Analysis
3. Results
4. Discussion
- *
- The synovial flap is the only flap capable of fully enwrapping the exposed median nerve, thereby effectively protecting the nerve against sprouting fibrotic tissue.
- *
- Donor site morbidity is minimal. This leads to a satisfactory cosmetic outcome, especially when primary wound closure is possible.
- *
- Dissection of the synovial flap is quick and simple, the learning curve short and the complication rate very low (based on personal observation).
Author Contributions
Funding
Conflicts of Interest
References
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Patient (n) | Age (Years) | Gender (F/M) | Side (l/r) Dominant Hand (+/−) | Number of Previous Interventions | Symptom-FreeInterval (Months) | Elapsed Time between Last Intervention and the Synovial Flap Plasty (Months) |
---|---|---|---|---|---|---|
1 | 32 | F | r + | 1 | 8 | 16 |
2 | 77 | F | r + | 1 | 6 | 17 |
3 | 56 | M | l + | 2 | 5 | 14 |
4 | 64 | M | r − | 1 | 10 | 27 |
5 | 46 | F | r + | 3 | 4 | 15 |
6 | 22 | F | l + | 1 | 5 | 13 |
7 | 51 | F | l −/r + | 1 | 9/6 | 18/24 |
8 | 62 | F | l + | 2 | 7 | 18 |
9 | 48 | M | r + | 1 | 12 | 26 |
10 | 43 | F | r − | 1 | 14 | 29 |
11 | 42 | F | r + | 1 | 11 | 20 |
12 | 51 | F | r − | 1 | 13 | 24 |
13 | 41 | F | l + | 1 | 8 | 20 |
14 | 44 | F | r + | 1 | 9 | 23 |
Nerve | Primary Wound Closure (Yes/−) | Integument Enlargement (Yes/−) | Motor Distal Latency (msec) Pre/Post | Normative Values of Distal Latency | CMAP (μvolt) Pre/Post | Sensory NCV (m/sec) Pre/Post | VAS Pain Pre/Post | VAS Limitations of Activities Pre/Post | Levine Pre/Post |
---|---|---|---|---|---|---|---|---|---|
1 | Yes | − | 4.5/3.6 | 2.8 | 11849/12833 | 43/46 | 9/2 | 7/2 | 3.4/1.9 |
2 | − | Yes | 5.7/4.4 | 3.0 | 8927/9596 | 37/41 | 9/2 | 9/2 | 3.8/2.7 |
3 | − | Yes | 4.4/3.5 | 3.0 | 7756/9014 | 33/35 | 10/4 | 10/4 | 4.0/2.8 |
4 | − | Yes | 5.0/3.8 | 3.1 | 10679/13415 | 40/40 | 9/2 | 7/2 | 3.6/2.0 |
5 | − | Yes | 6.7/5.4 | 2.8 | 5483/7797 | 28/30 | 10/3 | 10/5 | 4.4/3.3 |
6 | Yes | − | 4.9/3.0 | 2.8 | 14123/14632 | 48/54 | 8/3 | 6/3 | 3.0/1.1 |
7 | Yes | 4.7/3.6 | 2.8 | 11619/12110 | 38/41 | 8/2 | 6/2 | 3.9/2.3 | |
8 | − | Yes | 4.9/3.6 | 2.8 | 9013/10318 | 39/43 | 8/2 | 8/2 | 3.5/2.1 |
9 | − | Yes | 5.6/4.6 | 2.9 | 7987/9583 | 31/35 | 8/2 | 8/2 | 3.3/2.4 |
10 | − | Yes | 4.6/3.3 | 3.2 | 9365/12846 | 36/39 | 9/3 | 5/1 | 3.8/2.9 |
11 | − | Yes | 5.3/3.6 | 2.8 | 9190/10129 | 45/47 | 8/1 | 8/1 | 4.1/3.2 |
12 | Yes | − | 4.9/3.8 | 2.8 | 10241/12299 | 40/43 | 8/3 | 6/3 | 3.2/2.4 |
13 | − | Yes | 5.0/3.8 | 2.8 | 8421/9958 | 41/42 | 9/1 | 9/2 | 3.9/2.5 |
14 | Yes | − | 5.6/4.7 | 2.8 | 10593/11727 | 39/41 | 7/1 | 7/3 | 3.6/2.9 |
15 | Yes | 4.7/3.4 | 2.8 | 11797/11958 | 34/37 | 8/1 | 6/1 | 4.0/3.0 |
Pre-op [MV] | Post-op [MV] | Significance | |
---|---|---|---|
Distal Latency * | 5.1 | 3.8 | p < 0.05 |
CMAP | 9802.9 | 11214.3 | p > 0.05 |
Sensory NCV | 38.1 | 40.9 | p > 0.05 |
VAS Pain * | 8.5 | 2.2 | p < 0.001 |
VAS Function * | 7.5 | 2.2 | p < 0.001 |
VAS Satisfaction | − | 2.4 | |
Levine * | 3.7 | 2.25 | p < 0.001 |
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Payr, S.; Tiefenboeck, T.M.; Moser, V.; Turkof, E. Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient’s Satisfaction and Improved Functionality. J. Clin. Med. 2019, 8, 2094. https://doi.org/10.3390/jcm8122094
Payr S, Tiefenboeck TM, Moser V, Turkof E. Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient’s Satisfaction and Improved Functionality. Journal of Clinical Medicine. 2019; 8(12):2094. https://doi.org/10.3390/jcm8122094
Chicago/Turabian StylePayr, Stephan, Thomas M. Tiefenboeck, Veith Moser, and Edvin Turkof. 2019. "Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient’s Satisfaction and Improved Functionality" Journal of Clinical Medicine 8, no. 12: 2094. https://doi.org/10.3390/jcm8122094
APA StylePayr, S., Tiefenboeck, T. M., Moser, V., & Turkof, E. (2019). Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient’s Satisfaction and Improved Functionality. Journal of Clinical Medicine, 8(12), 2094. https://doi.org/10.3390/jcm8122094