In Reply: We read with interest the letter from Monacelli et al. about our article (3). As we know from several publications, the gliding, biocompatible, and bioreabsorbable hyaloronic acid gel improves the outcome of patients who undergo carpal tunnel release, at least in the first week after surgery. From the clinical point of view, this translates into better compliance and earlier recovery of patients in whom the gel is used (2). The rationale of hyaluronic acid use is based on its prevention of adherence syndromes and on the necessity of proximal stump preservation from mechanical and thermic stimuli that are responsible for the typical symptoms of neuromas. But the ideal treatment of persistent or recurrent CTS has not yet been determined, and a great variety of methods have been recommended to ameliorate this problem. Many procedures are possible, including neurolysis, local flaps, fat grafts and flaps, vein wrapping, and synovial flaps. The outcome of revisional carpal tunnel surgery is only fair; therefore, avoiding the secondary procedure is currently the best treatment. We should be aware of traction neuropathy in primary and revisional carpal tunnel surgery. Providing the nerve with a gliding surface by placing the skin incision more ulnarly at primary surgery, with local or distant tissue coverage in revision surgery or with artificial substances in primary or secondary carpal tunnel release should be the first aspect of interest (4). We used fat and synovial flaps because they provide a well-vascularized tissue that readily covers the scarred median nerve, and they are thick enough to cushion this vulnerable part of the hand. Monacelli et al. achieved good functional outcomes and satisfaction by using local anesthetic infiltrations for pillar pain after carpal tunnel decompression (1). Nicolas Stütz Nuremberg, Germany Alexander Novotny Munich, Germany Andreas Gohritz Hannover, Germany