Ｐａｌｍａｒｉｓ ｂｒｅｖｉｓ ｔｕｒｎｏｖｅｒ ｆｌａｐを用いて治療した手根管開放術後の２例

Abstract

We successfully treated recurrent and persistent carpal tunnel syndromes with neurolysis and palmaris brevis turnover flap with hypothenar fat.A 53-year-old female received carpal tunnel release 19 months ago. Night pain and paresthesia were once resolved after surgery, however, symptoms recurred after 9 months. On examination, Tinel sign along the operative scar and positive Phalen test were found. Two-point discrimination of the thumb was 8mm but motor weakness was not found and terminal latency was within the normal range. Intraoperative findings revealed that the median nerve migrated volarly and adhered to the dorsal aspect of the sectioned flexor retinaculum. After the index surgery, night pain resolved immediately and only slight numbness remained at 18 months after surgery.A 67-year-old female received carpal tunnel release 12 months ago. Pain in the palm started, and night pain and paresthesia worsened after surgery. On examination, we found Tinel sign along the operative scar, positive Phalen test, weakness in thumb abduction and mild delay in terminal latency. Operative findings were volar migration of the median nerve surrounded by the scar tissue. After the index surgery, night pain disappeared immediately and she has been symptom-free for 16 months.